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March 08, 2010

Comments

If the "death tax" is abolished, all of them will keel over immediately

Well, what are they waiting for?
Isn't this the year that the Throw Momma From The Train Act of 2001
reaches fruition?

--TP

Carry on trolling; you're clearly not worth responding to further.

Posted by: Uncle Kvetch | March 09, 2010 at 11:38 AM

But UK, I'm a very accomplished troll. You've misjudged again.

Posted by: Slartibartfast | March 09, 2010 at 11:42 AM

...you have always disappointed. I've always liked John Thullen better. Internet Assertion Monkey. How rude.

Blogbudsman: Yet: "In 2006, 46.6 million Americans were without health insurance.

Posted by: Jesurgislac | March 09, 2010 at 11:17 AM

You have been misinformed.

Oh noes! You're right, Blogbudsman - according to the CDC, the figure for 2006 was actually 43.6 million - 14.6% of Americans. The figure I quoted to you was 3 million out.

I've always liked John Thullen better.

Everyone likes John Thullen better.

Internet Assertion Monkey.

That does have a nice, punchy ring to it.

Who the cap fit, brah.

Nice shout out to Otis on your blog page, blogbudsman. Respect where it's due.

Jes: The figure I quoted to you was 3 million out.

That must be the three million that the Republican plan was going to cover.

I assert that Slartibartfast at 11:22 is correct.

The data clearly shows that the US health system (1)is by far the most expensive per capita in the world, (2) still manages to leave approximately 15% of the population uninsured, and (3) still manages to produce poorer overall health outcomes than most other OECD countries.

From what I've seen here and elsewhere, a common response from the US political right is:
(1) Costs are high because of government interference in the health insurance/health care market place. Stop the government interference (except when you need to increase it by limiting lawsuits) and costs will plunge.
(2) Tens of millions of people are uninsured (and tens of millions more under insured) because they are illegal immigrants or because of government interference in the market, or perhaps because they want to be.
(3) Data on health outcomes is meaningless because it is skewed by all those poor illegal immigrants and/or because Americans eat and drink more than anyone else in the world.

I can't stand John Thullen

...you have always disappointed.

Sorry to disappoint, truly. But I don't do this for you.

I've always liked John Thullen better.

Me, too. Although it's good to keep in mind that he's either clinically insane, or a mad genius, or both. So comparisons would either be unflattering to one of us; possibly both.

Internet Assertion Monkey. How rude.

I present a general garment, and you claim it is cut to your fit? Or some such.

Either you're arguing by assertion, or you're not. If you are, wear the label proudly, or quit doing it. If not, I'm not talking to you.

according to the CDC, the figure for 2006 was actually 43.6 million

Slightly more nuanced, it's:

In 2006, 43.6 million persons of all ages (14.8%) were uninsured at the time of the interview, 54.5 million (18.6%) had been uninsured for at least part of the year prior to the interview, and 30.7 million (10.5%) had been uninsured for more than a year at the time of the interview.

Even if you want to try and play with the at the time of the interview notion, there's still the part where over 30 million had been uninsured for more than a year, prior to the survey.

Yukoner. The US health system is so expensive that the US government already spends just as per capita as the UK and Canada, but covers much less than all of the population.

Here are my thoughts, as of now, about the broader question of HCR in the US, based on whatever information I've stumbled across over the last year.

Regardless of who pays for it, or how, health care costs in the US are on track to basically cripple the economy.

What the various payers in the US mostly pay for are direct hospital care and physician visits, and (to a lesser but still significant degree) prescription pharma.

The folks who consume those services and meds are overwhelmingly people with chronic illnesses like diabetes, cancer, pulmonary and cardiac issues.

*Most of these illnesses are manageable*, to at least some useful degree, by fairly simple and fairly inexpensive lifestyle changes.

Don't smoke.
Don't drink too much.
Get some exercise.
Don't eat overly processed food and/or stuff that's loaded with corn syrup or other sugars.

It seems to me that *none* of the reforms on the table, from either side, do anything serious about addressing that basic reality.

Health care costs a lot in the US.
It costs a lot because a lot of people are sick.
A lot of people are sick because of preventable lifestyle issues.

And when I say "lifestyle" issues, I don't mean that people should get off their lazy duffs and get with the program. I think there are some deep issues at the infrastructure level that make it suprisingly hard for folks to have access to good food and opportunities for simple, pleasant exercise.

So, to my eye, a rational way to go about this would look more like a public health outreach at a national level, to encourage the production and availability of healthy food, to help people understand how to buy and prepare it, and to help people get some exercise.

Public health services and education.

How does this strike the conservative mind?

Does it sound like a program for encouraging people to take responsibility for their health, and empowering them to do so?

Or does it sound like more liberal meddling of the "Obama is going to make me eat kale" variety?

Just curious.

How does this strike the conservative mind?

Dunno. I've heard in various places that I'm not conservative, and also that I'm a rightwing wacko. But, speaking for myself: I think that attention to diet, exercise, and refraining from smoking are GOOD things.

But enforced attention rubs me the wrong way. Having a decent health program starting in elementary school, though, seems to me a decent way to lay the groundwork for informed choice.

Having a decent health program starting in elementary school,

indoctrination!

Funny, Thats exactly how I feel this went, what is odd is that the discussion, mine and Russells was about whether the numbers were good or not. That requires interpretation or, opinion....
50% greater than 2 weeks with 14% still not done at 3 months doesn't sound great to me

That's not what you said at all; you acted as if the 14% would be applied equally to all patients. Specifically, you said It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it.

That's as dishonest as the people quoting the average wait for a voluntary hip replacement and pretending that grandma would be laid up with a broken hip for months.

I am not sure what your objection to my opinion is other than you disagree.

I object to the attempt to use the statistics in an obviously misleading way. And again, if you have all this direct experience with the Canadian medical system, that should have directly demonstrated to you that that eg people don't regularly sit around for 3 months waiting to find out if they've got brain cancer.

Sebastian,
Yes I've seen the numbers that you are referring to. It seems that you have the worst of all worlds and that means the most expensive one by default. All health care systems are obviously subject to upward pressure on costs but in the US these pressures seem to be magnified greatly.

Where is the push back on that upward pressure in the US? Medicare Part D started paying for senior's medications but the program was forbidden to use its buying power to negotiate better prices. The current effort at reform includes some plans to reduce Medicare expenditures and the political right pivots 180 degrees to attack any effort to reduce costs at all. Cost containment on the Medicaid program appears to be largely limited to dropping poor people off the rolls which is unlikely to result in actual cost savings but never mind. And the incentives of the private insurers are so mis-aligned with the goal of overall health care system efficiency and cost containment that looking to them for pressure to contain costs is a joke.

Two advantages of a single payer system in this context:
1. There are very real system-wide pressures to contain costs along with the pressures to maintain or increase services. Hence the ongoing issue of wait times in Canada for example.
2. But because everyone will be in the wider health care system from cradle to grave, some of those pressures to reduce costs are channeled into long-term efforts like public health programs and campaigns. One example among many is the on-going long-term multi-faceted effort to reduce the incidence of Type 2 diabetes that is particularly common among First Nation and Inuit people. Up front costs are considerable but it appears that long term savings will dwarf those costs.

Part of our cost overruns are attributable to our overuse of tests and procedures in general, but in particular, the excessive, unnecessary and, in some cases, unethical end of life care.

Sebastian is correct: the US government pays through the nose for the health care it buys, just like private insurers do and just like individual citizens do.

It's a wonder (to some) where all the money goes. It doesn't go into hiring more doctors per capita than, say, France or Germany do. But it goes somewhere because you can't spend money without it becoming income for somebody.

The US healthcare "system" is a jobs program for lots and lots of people. Some of them spend their time creating forms; others spend their time filling out the forms. Some of them create ads for their company's boner pills; others create ads for their company's competing boner pills. They may be contributing nothing to anybody's health, but at least they get a paycheck -- which is no small thing in today's economy. "Reducing health care costs" can ONLY mean pay cuts or outright lay-offs for at least some people who now earn their living in the US healthcare "system". (Well, it could also mean lower profits for some stockholders, but those are too sacred to touch, as we know, and too small to matter, as Sebastian has told us in the past.) So, in light of 10% unemployment, "reducing health care costs" is not unalloyed goodness.

Rejiggering the "system" so that the same total spending (i.e. the same total wages and profits) results in medical care for the people who are now going without it WOULD BE unalloyed goodness.

Some romantics believe that we should rejigger the "system" towards that gauzy past that Ronald Reagan melifluously reminisced about in his famous hit single inveighing against Medicare. To such starry-eyed idealists, all I can say is: we tried it your way up to 1965. IT DIDN'T WORK. So we hard-nosed libruls stepped up and did something: old people don't go uninsured any more. Medicare was not a commie plot against The Market; it was a solution to a problem that The Market could not (or would not) solve.

Yeah, it was socialism. But one thing you CANNOT say about it is that it stunted the growth of the "health care industry". Socialism is good for business more often than you think.

Russell is correct, too: staying healthy is absolutely, positively better than getting medical treatment -- no matter how "efficient" the health care "system" is.

One thing I'd add to his list is the possibility that some of our health problems are due to stress. But don't tell the drug companies, or we will start seeing TV ads for a pill to relieve Insurance Anxiety Disorder.

--TP

But enforced attention rubs me the wrong way.

I guess I was thinking more along the line of carrots rather than sticks.

No pun intended.

"Reducing health care costs" can ONLY mean pay cuts or outright lay-offs for at least some people who now earn their living in the US healthcare "system".

They could become small-scale organic farmers!!

Imagine their delight!

Or, maybe some would enjoy it.

But don't tell the drug companies, or we will start seeing TV ads for a pill to relieve Insurance Anxiety Disorder.

I think that pill is called "Jack on the rocks, soda back".

Person A and Person B are the same age.

Person A has good health insurance and Person B has none.

Person A gets regular check-ups, which are covered by insurance, requiring Person A to pay a $10 or $20 co-pay.

Person B does not get regular check-ups because of lack of coverage.

Person A’s doctor finds something unusual during a routine check-up and sends Person A for further tests, which are completed within a few weeks.

Person A is found to have a disease in an early and easily treatable stage.

Person A receives treatment within a few weeks and eventually recovers fully, going on to live for a number of years or decades into the future.

Person B has the same disease in the same early stage as Person A’s at the same point in time, but doesn’t know it.

Person B, several months later, begins to experience symptoms and treats those symptoms with over-the-counter medications.

Person B’s symptoms, a couple of months later, become bad enough that Person B goes to the ER.

Person B’s disease is found to be advanced and terminal.

Person B goes home and informs friends and family of these circumstances.

A few weeks later, Person B is rushed to the hospital by ambulance.

Person B lives another week in the ICU on morphine before dying.

How should we calculate Person A’s and Person B’s wait times for treatment? Person A’s is a few weeks. Person B’s is more complicated. One could argue that Person B’s wait time for treatment is infinite, having never received it. I don’t think that would be fair. One could argue that Person B’s wait time should be the number of months that Person B lived with the disease that killed Person B. I don’t think that would be fair, either. I think Person B’s wait time should be based on the number of years or decades Person B would have lived had Person B been treated as quickly as Person A, regardless of their respective citizenships.

End-of-life care makes me crazy. There are some difficult questions about assessing when "end of life" is actually occurring, but there is a particularly perverse combination of expensive, painful, invasive interventions, and overcautious, miserly use of heavy painkillers & anti-anxiety drugs because of the fear of theft of painkillers or accidentally killing someone who is already bound to die.

It's screwed up even in the best cases, and it's horrific in the worst.

I guess this is more fuel for "You want death panels for grandma!" but when I hear that kind of crap, I think about my actual grandmother (still alive): survived the Blitz in London, saw her husband die in his 60s, kept on going for several more decades; recently got a scan in the hospital for something else in which they noticed what might be kidney cancer; as the doctors began discussing biopsy and invasive treatment options, said something along the lines of "Are you kidding? I'm going to die of SOMETHING someday and I'd rather it not come at the end of a long series of painful surgeries." I hope I have that much grace when someone comes to me with that kind of question.

And yes, I'll be very sad when she dies. But we're all going to die someday; all anyone can really hope for in the end is some dignity and relief from pain. The way we talk about death from old age or major disease is very warped in this country. There are no deranged bureaucrats bent on killing your grandmother: being confined to a hospital bed, drugged out of your mind, and having repeated surgeries and other interventions is not a good way to go out, even if cost never entered into it.

Answer:

If person A is Rush Limbaugh, he's headed for Costa Rica to suck off their socialist healthcare paradise, if Obamacare is passed.

If person B is Rush Limbaugh, Glenn Back will quit his church if Limbaugh, heretofore known as person B, receives either a trip to the hospital via ambulance or a week's worth of morphine in the name of social justice.

'Person A and Person B are the same age'

Not enough information about Person B. If Person B can get the check-ups needed without insurance coverage, then why doesn't that happen? The only situation I can think of with which I empathize is that Person A is destitute and cannot make the choice to pay for the regular check-ups. But this condition has been with us for a long time. I know lots of young people who forego health insurance coverage but rarely do the same for all the modern technology they view as integral to their modern existence. When they encounter a situation like that faced by Person B, it is very sad, but clearly from a perspective different from described in the posted scenario.

Jacob: I hope I have that much grace when someone comes to me with that kind of question.

Me too. I salute your grandmother, and you too for taking her decision like that.

My great-aunt had one bad heart attack, multi-infarct dementia causing short-term memory loss, and osteoparosis (several bad fractures). She was fragile, stubborn, damaged, and ... well, stubborn: she was absolutely bloody determined that she was going to die in her own bed at home, not in a hospital or a care home, and she got her way to the end. (She died of a second heart attack just before the end of 2001: at home, in her own bed, just as she'd wanted.)

She got a fair amount of fairly expensive support from the NHS and from the local authority to be able to live in her own home, and help from her neighbours and her family. The cost of her stay in a care home would have been considerably greater to the local authority, possibly less to the NHS, but the choice was always hers. (She was quite clear about that, and made sure everyone else was, too.)

Um, what? That aside, where ya been, GOB?

'where ya been, GOB?

All is well. Just taking care of things in Utah. Many posts here are on foreign relations and military actions that don't interest me nearly as much as the domestic threats to American liberty. So, when I have a chance, I stop by to see if I can throw a wrench into the works.

GoodOleBoy: So, when I have a chance, I stop by to see if I can throw a wrench into the works.

As Slarti pointed out upthread: the trouble with all the right-wing defenders of the US's p!ssspoor healthcare system, is that they are attempting to win an online argument without any facts on their side. When you have to claim you believe you have a wrench and if you did then you could throw it and you're sure that if you threw the wrench you don't have it would somehow land in the works...

Thullen can do better, and often does.

'without any facts'

I rarely quarrel with you about the facts. Facts about results/outcomes dominate the world of the progressive. The fact I do pay attention to is the failure to acknowledge the meaning of the content of the U.S. Constitution and the notion of the separation of powers among the federal and state governments and the people. Most of the facts cited here drive progressives to advocate actions at the federal government level that diminish my opportunity to make my own choices, which, in my estimation, is the essence of my individual liberty. It's very elementary and requires few facts.

But Jes, you are subject to a health care system that denies you your liberty, so why should we listen to anything you say? It's obvious that if you were to write what you really thought of the NHS on this blog, MI5 would have you shipped off to the British version of the gulag faster than you can say "Bob's yer uncle."

Unless, of course, you've been so thoroughly brainwashed from spending your life under the jackbooted heel of socialism that you can't see universal health care for what it really is: a boot stomping on a human face...forever.

Part of our cost overruns are attributable to our overuse of tests and procedures in general, but in particular, the excessive, unnecessary and, in some cases, unethical end of life care.

You forgot profitable.

Freedom's just another word for dying a slow and painful death from a treatable disease that goes untreated due to a lack of health insurance.

Most of the facts cited here drive progressives to advocate actions at the federal government level that diminish my opportunity to make my own choices, which, in my estimation, is the essence of my individual liberty.

personal liberty is only affected by laws at the federal level ? fascinating!

how do "conservatives" explain the fact that i can only buy the brands of Scotch that the state of North Carolina approves of ? other than the number of people they effect, how would the laws governing this be any different if they were applied at the federal level ?

GOB,

Does MY liberty count? I want to be able to make "my own choice" to buy my health insurance from the federal government. Would it be any skin off your nose if I had that choice?

--TP

Many posts here are on foreign relations and military actions that don't interest me nearly as much as the domestic threats to American liberty.

"Who cares about us killing more brown people? I'm more concerned that I'm not allowed to just do whatever I want all the time!" What a mature outlook.

Apropos of the thread, I'll be offline for a few days due to having hernia repair surgery tomorrow. I'm glad I'm one of the people in the US with good coverage.

Good Ole Boy: Most of the facts cited here drive progressives to advocate actions at the federal government level that diminish my opportunity to make my own choices, which, in my estimation, is the essence of my individual liberty.

Then you should welcome the advent of the US's NHS, which would vastly increase your opportunity to make your own choices, and thus your individual liberty.

Or do you actually value your individual liberty so little that you'd oppose increasing your personal choices - and everyone else's, too - by having the NHS in the US?

I wonder how GOB feels about the Federal government taking away his choice to decide for himself whether to spend money on killing Iraqis? Or the state of Utah taking away the choice of bar owners to offer happy hour drink specials?

"The only situation I can think of with which I empathize is . . "

That's ... interesting phrasing, Good Ole Boy . . .

Is the stop light I'm approaching at the busy intersection up ahead there because of local, State or Federal mandates, or some combination thereof?

I'm going 42 mph, so hurry up with the answer. Plus I'm texting (and making waffles on my car's built-in waffle-making feature), which makes the ride even more fun.

My sense of individual liberty and its essence -- my ability to choose -- are at stake.

If there is any Federal money (my stolen tax dollars) in that stop light and the law that says I must obey, I think I'll speed up and run it to make a statement about my liberty.

I had my liberty diminished once in Utah; some cop wouldn't let me make my own choice about how fast I wanted to go.

Well, I could make my own choice, but I had to pay Utah for the privilege.

Here I go.

"Part of our cost overruns are attributable to our overuse of tests and procedures in general, but in particular, the excessive, unnecessary and, in some cases, unethical end of life care."

I *think* you are probably right about this. But why hasn't there ever been a good study on this? I've looked for years and never even seen a good try at it. Is there one somewhere?

If Person B can get the check-ups needed without insurance coverage, then why doesn't that happen?

The problem is that Person B can quite often not get the check-ups and/or other care without insurance coverage.

If Person B could do so without insurance coverage, there wouldn't be an issue.

The only situation I can think of with which I empathize is that Person A is destitute and cannot make the choice to pay for the regular check-ups.

I think you mean Person B here.

As it turns out, you have plenty of opportunity to exercise your capacity for empathy, because lots of folks are either already too poor to get the care they need, or they are bankrupted by getting the care they need.

But this condition has been with us for a long time.

Yes, it's true, the poor and otherwise unlucky are with us always.

Is your argument that we should therefore do nothing about it?

I know lots of young people who forego health insurance coverage but rarely do the same for all the modern technology they view as integral to their modern existence.

Perhaps you may wish to compare the prices of, frex, privately purchased health insurance coverage, or the out-of-pocket cost of any medical procedure more complex than an office visit, with the prices of consumer electronics.

Of all of the arguments against doing something about the health care situation in this country, the one for which I have the least sympathy is the argument that any government action that limits anyone's personal choice is an affront to their personal liberty.

You can't drive above the speed limit. If you build a house, it has to be to code. If you're a smoker, you can't smoke in most confined public places. You can't own a bazooka or a tank. You can't dump your bodily wastes in a drinking water source.

And so on.

These are all limitations on your personal liberty. We accept them because it makes it possible for the 300 million of us who live in this country to get along. Or, in other cases, means that the requirements for a plainly decent life are broadly available to all.

I don't see anything in the constitution that says the federal government cannot regulate the insurance industry, cannot directly provide insurance if that's what we want to do, or cannot directly provide care if that's what we want to do.

If you see it in there, kindly show it to me. Because I don't see it.

What you're saying, GOB, is that *you don't like it*.

When tens of millions of people are totally uninsured, and half of all bankruptcies are due to medical costs, and tens of thousands of people a year die for lack of access to care, that is simply not a good enough reason for government not to act.

I *think* you are probably right about this. But why hasn't there ever been a good study on this? I've looked for years and never even seen a good try at it. Is there one somewhere?

While not a comprehensive study this story on the costs of end-of-life care is hot off the presses.

It does cite a 2008 cost study showing large cost differences between different top-notch U.S. hospitals (end of life costs averaging $93k at UCLA Medical Center vs. $53k at Mayo in Rochester, MN).

Naturally, supporters of UCLA Medical Center suggest that the study is flawed.

The people I know who work in medicine have plenty of stories of hopelessly-ill elderly patients receiving expensive procedures unlikely to improve the patient's quality of life because the patient and/or the patient's family wanted them to "do everything".

Over on the other side of the Pacific, I just had a lesson with my iaido teacher, and his older sister (she's 87, he's 80 or 81) had moved down from Tokyo to live with them. My lesson started an hour and a half late because the town they live in sent someone new to do the 3 month survey of her health issues/abilities in order to set the level of care that she is eligible to receive. Because the new person had to familiarize herself with all of the issues and get to know her, the meeting took more time than it usually does. After that, my teacher's sister is then eligible for various benefits (transportation to the day care center, physical therapy, etc) and the case worker is familiar with the issues, so when the time comes, she will be able to help in making decisions.

End of life care is not going to be reduced by fiat, it is going to be reduced if systems are put in place to help deal with the issues that arise. In the US, death is often put off, and the end, when it comes often seems sudden because there is very little infrastructure in place to help people understand the cost/benefit ratio.

Furthermore, the structure of insurance encourages hospitals to make drastic interventions based on profits and volume. There was one of those infographs in Harpers maybe 7 or 8 years ago that took the medical bill of a person in the last week of their life and analyzed what was being paid for, why it was being prescribed, and what it meant. Unfortunately, it is not online, but the cost was mind boggling, all to keep someone 'alive'. (I think that some of the prescribed procedures suggested that the person was not conscious when all this took place)

Unfortunately, that kind of infrastructure necessitates a systemic approach, but if it is argued that this is socialized medicine and therefore is unacceptable, I don't see the US making much headway.

"Unfortunately, that kind of infrastructure necessitates a systemic approach, but if it is argued that this is socialized medicine and therefore is unacceptable, I don't see the US making much headway."

lj,

I am not sure the US, in this particular only, is that far behind. My father has regular checkups, a significant amount of similar benefits (transportation to daycare, physical therapy)and a case worker very familiar with his particular issues.

I am not sure what this means though:

In the US, death is often put off, and the end, when it comes often seems sudden because there is very little infrastructure in place to help people understand the cost/benefit ratio.

Does the case worker decide how to end the life? Not commenting or complaining, just asking whether this is an active or advisory role in the decision process.

The problem is that Person B can quite often not get the check-ups and/or other care without insurance coverage.

Or, Person B realizes the futility of getting a diagnosis they can afford but not having the money to treat it.
Of course, anyone comparing the price of an iPod to the price of privately-purchased insurance (with exceptions for pre-existing conditions, of course) isn't exactly dealing with the real world anyway.

Having someone familiar with the issues, who is outside of the family, can make a big difference. I'm not sure what I wrote that suggests that care workers here do (or should) have that kind of decision power and I apologize if I left you with that notion. What I am suggesting is that if the situation faced by someone is only know by people who either have certain stakes in the issues (i.e. the family) and people who come in only at the very end (medical staff), it is going to be difficult to arrive at a decision that won't be skewed in some way. A regular checkup has, it seems to me, a different purpose than a 4 times a year survey interview that attempts to determine the physical limits and challenges a elderly person faces. One is reminded of the old joke where the man says 'doc, it hurts when I lift my arm' and the doc says 'well, don't lift your arm'. The joke doesn't work if you say 'doc, my joints hurt cause I'm getting old' and the doc replies 'well, don't get old'...

Marty: I am not sure the US, in this particular only, is that far behind.

I'm glad your dad's getting good care.

You do realize that a single anecdote is meaningless, just as you did realize (but claimed it anyway) that comparing Canadian wait times with imaginary "US wait times" is meaningless?

...and you do realize that insofar as care for the elderly is covered by Medicare, older people in the US have a socialized health care system which would be a great advantage to them in bringing up their standard of care to the rest of the developed world, unlike the rest of the US falling far below it?

[...]
There is no systemized collection of data on wait times in the U.S. That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public. However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.

The Commonwealth survey did find that U.S. patients had the second-shortest wait times if they wished to see a specialist or have nonemergency surgery, such as a hip replacement or cataract operation (Germany, which has national health care, came in first on both measures). But Gerard F. Anderson, a health policy expert at Johns Hopkins University, says doctors in countries where there are lengthy queues for elective surgeries put at-risk patients on the list long before their need is critical. "Their wait might be uncomfortable, but it makes very little clinical difference," he says.

The Commonwealth study did find one area where the U.S. was first by a wide margin: 51% of sick Americans surveyed did not visit a doctor, get a needed test, or fill a prescription within the past two years because of cost. No other country came close.

Few solutions have been proposed for lengthy waits in the U.S., in part, say policy experts, because the problem is rarely acknowledged. But the market is beginning to address the issue with the rise of walk-in medical clinics. Hundreds have sprung up in CVS, Wal-Mart, Pathmark, and other stores—so many that the American Medical Assn. just adopted a resolution urging state and federal agencies to investigate such clinics as a conflict of interest if housed in stores with pharmacies. These retail clinics promise rapid care for minor medical problems, usually getting patients in and out in 30 minutes. The slogan for CVS's Minute Clinics says it all: "You're sick. We're quick."
The Doctor Will See You—In Three Months (JULY 9, 2007)

[...]
The take-away message is that both the United States and Canada do pretty poorly, compared to most other industrialized countries, on how long patients have to wait to get a regular appointment with a primary care physician or after-hours care, but the U.S. does better than most on having shorter wait times for diagnostic procedures, elective surgery, and specialty care. Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn’t seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.
[...]
Wait Times For Medical Care: How The US Actually Measures Up

Fred at Slacktivist explains the difference thusly: Marty, Blogbudsman, McKinneyTexas, and GOB are playing Family Feud. The rest of us are playing Jeopardy.

For other options there's also QI, where you get klaxon'd by Stephen Fry if you give the dull/wrong answer (though even Alan Davies wouldn't be as boring as "America has the best healthcare in the world!"), Have I Got News For You, where you get points for the right answer but get asked back more often if you're funny (alumni include both the first and the present Mayors of London), Call My Bluff, where you can win points for inventing convincingly wrong definitions of unusual words, and The Price Is Right, where at least you get Bruce Forsyth to flirt with you, though it appears most right-wingers would be really bad at figuring out how to get the prize...

Fred at Slacktivist explains the difference thusly: Marty, Blogbudsman, McKinneyTexas, and GOB are playing Family Feud. The rest of us are playing Jeopardy.

That's a brilliant (and very funny) analogy.

how do "conservatives" explain the fact that i can only buy the brands of Scotch that the state of North Carolina approves of

That does defy explanation. As do Texas' dry districts, if they still exist.

Apropos of the thread, I'll be offline for a few days due to having hernia repair surgery tomorrow.

My best wishes for a successful procedure and speedy recovery, Phil.

As Slarti pointed out upthread: the trouble with all the right-wing defenders

Just to be clear, it wasn't right-wing defenders in general; just one or two in this thread. YKWYA, and so does everyone else.

Argument by assertion is just a giant waste of space, I assert.

For other options there's also

You're missing the radio choices. I can only wish that those playing Family Feud (Family Fortunes in the UK) were playing Just a Minute - that way we wouldn't have to deal with continual repitition of false talking points, and regular deviation to irrelevance. But sometimes it seems more like the pre-scripted parody I'm Sorry I Haven't A Clue with rounds such as One Song to the Tune of Another, Cheddar Gorge (where you avoid the last word in the sentence - or the last thought in the chain of reasoning), Pick Up Song, and Swannee Kazoo (where you play duets on the Swannee Whistle and the kazoo).

...slip in between the cracks in her death panels...

pedant

Stuff slips through cracks, not between them. What is between the cracks is the intact solid stuff, where there is no crack to slip though.

/pedant

I *think* you are probably right about this. But why hasn't there ever been a good study on this? I've looked for years and never even seen a good try at it. Is there one somewhere?

Seb, there was a 60 Minutes segment a few months ago, and I believe it cited studies. Here is a write up that might provide some leads:

http://www.cbsnews.com/stories/2009/11/19/60minutes/main5711689.shtml

Let me try that again, with a proper link

Charles: Do you think those links help you? They may make a point about Canadian wait times, but they also make a point about US wait times vis-a-vis other nations with universal coverage (some with government run health CARE like the UK). From the link:

However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.

Further:

Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn’t seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.

Right.

Francis D,

Or in the case of Rush Limbaugh, I think the old Hoosier Hotshots song "From the Indies to the Andes in his Undies" fits the bill.

"Charles: Do you think those links help you?"
I'm not looking for any help. I say let the truth, to the degree it can be determined, fall where it may. I'm just throwing wood on the fire. :)
Obama is going to make me eat kale

OT, I had some kale last night that I'd just picked from my garden, and it was fanTAStic! Loads better than those bags of pre-cut and -cleaned kale that you get at the local supermarket (which I'd thought were pretty good, until). Also, some garden spinach of a variety I'd never had before: huge leaves, a slightly tart flavor, and none of that dry-teeth effect you get from conventional (uh: garden-variety?) spinach.

Another thing that is really a whole lot better fresh from your garden: cabbage. Which we have still about a dozen heads of. I go cut a head, strip off some of the exterior leaves, and then cut it up for cooking. It's so crisp that a VERY sharp knife makes kind of a ripping, shattering noise when cutting it. Tastes like nothing you're likely to get from the store, even from a farmer's market.

Other stuff we're growing: sugar snap peas (which don't even make it to the sink, most times. We just eat them right off the plant), turnips, collards, broccoli, lettuce (all done, now; time to replant), kohlrabi, broccoli (also all done & time to replant), brussels sprouts (experimental; never done those before) and the aforementioned spinach and kale.

Plus, we're still eating the sweet potatoes we harvested back in November.

OT, I had some kale last night that I'd just picked from my garden, and it was fanTAStic!

I prepare with olive oil and garlic and it's as you say, amazing.

Another thing that is really a whole lot better fresh from your garden: cabbage

My favorite is arugala. When we grew in Vermont, it was spicy. Had a bite.

I'm not looking for any help. I say let the truth, to the degree it can be determined, fall where it may. I'm just throwing wood on the fire. :)

Well, good on you for that. Those links were illuminating.

Thanks for the link Eric. And that is the kind of reporting I've seen for decades which has made me suspect that we do spend too much at the end of life. But what it isn't, and doesn't seem to lead or allude to, is a study showing how Americans treat dying people differently than our counterparts in other countries, nor how much that difference costs.

I suspect that the answers are:

A) we refuse to give up much later;
and
B) it costs an enormous amount;

and further

C) neither US government nor US insurance companies are good at getting that to stop.

Suggesting: we need to have a serious nationwide conversation about when to give up.

BUT: I don't know if we really KNOW any of the presuppositions, and telling people that we have to stop treating grandma without knowing the answers is just going to cause enormous problems.

(And it leads to answers neither side likes: i.e. that personal choice is likely bankrupting us, and that the fun rhetorical targets the left loves [pharma prices, insurance companies] aren't really the useful focus)

Which is why I wish we had data. If pharma prices are 1% of the difference in cost of care and this overtreatment at death is 35% (which are half assed but IMO reasonable guesses) it instructs us where the discussion should focus.

But because this difference is much talked about, but so far as I can tell, not deeply studied, we flounder all over the place.

Where is my winning lotto ticket so I can fund a study?

I prepare with olive oil and garlic and it's as you say, amazing.

That's the way I prepare it. That, and a little bit of ham. Probably good pancini would be best, but we just use what's in the fridge; sometimes it winds up being a few last scraps of tasso. Just enough to give it a little flavoring. Honestly, though, fresh-picked kale could probably do without the ham.

One advantage of the "Obama makes us eat kale world" is I would quickly starve to death. Growing up in the south I ate everything from polk salad to collards greens, I no longer eat bushes. You can't force me to eat arugula.

The upside is that as I starved to death I am sure I would be able to find some black market Marlboros and start smoking again to pass the time.

I suspect that the answers are:

A) we refuse to give up much later;
and
B) it costs an enormous amount;

and further

C) neither US government nor US insurance companies are good at getting that to stop.

In addition to what you wrote (and in conjunction) I think part of the problem is actually Medicare - that is, Medicare's willingness to pay for too much (stuff like hip replacement for terminally ill patients). Add to that a medical culture that views death as a defeat (even though it is inevitable) that applies a default judgment of "keep the patient alive at all costs."

Suggesting: we need to have a serious nationwide conversation about when to give up.

What we should do is require people on Medicare to compile a living will, with specific instructions. What Palin mendaciously called "death panels." The thing is, many, many people would rather not be kept alive under all circumstances. But outside valid instructions, or a suitable, knowledgable health proxy, the default is "keep alive."

But, yeah, a conversation would be nice. Also nice: one side of the divide not using said conversation dishonestly as a cudgel.

I don't know if we really KNOW any of the presuppositions, and telling people that we have to stop treating grandma without knowing the answers is just going to cause enormous problems.

Right, but we can go the living will path first, and that would be a positive step that would obviate that concern.

Jes, I am really tired of you twisting and kvetching at everything I say endlessly and needlessly with no point.

LJ told a story about arelative as an example of how people are treated, interested I responde with a story about my Dad.

Your reply was a rebuke that my example wasn't worthy of consideration somehow, although no rebuke to lj for a similar story.

All that not to mwntion your story about choosing a doctor because he/she was in walking distance and provided you a doctors note to miss work for two weeks for a sinus infection.

Chill out or leave my posts out of your discussion. Whatever valid points you might make are certainly outweighed by the need to just find aomething wrong with anything I say.

Another thing that is really a whole lot better fresh from your garden: cabbage.

Dunno how you like to prepare it, but Cooks Illustrated has a recipe for cream-braised cabbage with lemons and shallots that's heavenly (albeit a bit indulgent).

As a garlic loving Italian, I like my cabbage with garlic and olive oil. Although I also add red pepper to the cabbage. For variety's sake.

Sebastian,
neither US government nor US insurance companies are good at getting that to stop.

This is what I was referring to up thread. It appears that the US system is such that there are no consistent pressures anywhere to contain costs. And, partly because end of life care appears to be a very strong profit center for hospitals and doctors, everything including the kitchen sink is thrown into the fray.

An anecdote. Several years ago a good friend of my mother had a recurrence of cancer (she had been more than 5 years free of it after an earlier bout). She very quickly saw the oncologist who had successfully treated her before. After some tests etc. he told her that this particular cancer could not be successfully treated, that all the radiation, chemo and so on in the world would do nothing but make her last few months a misery of nausea and so on. He wanted to refer her to a clinic specializing in pain control and palliative care. Not surprisingly she and her husband wanted a second opinion and quickly saw a second cancer specialist who agreed entirely with the first. Her husband demanded that the doctors give her the aggressive treatment anyway. "You have to do everything you can!" Both refused, saying that not only would the treatments do no good, they would actively harm her by destroying her quality of life over her last few months of life.

They were a wealthy couple and the husband insisted they go to the US for more tests and another opinion. And lo and behold at a private hospital in Los Angeles, they found a team of cancer specialists who were more than willing to offer a protracted course of very aggressive treatment. When my mother asked the husband later what the doctors had said about the prognosis at the time he recalled that they had not promised anything specific but had kept repeating that there was always hope. And this is what he wanted to hear, he was desperate.

The sick woman didn't want the treatment, she believed the Canadian oncologists and knew from previous experience just how awful the treatment was. But she gave in to her desperate husband and entered the LA hospital. The treatment did not extend her life at all (she died within a couple of days of what had been originally forecast)and she died far from home without being able to spend time with her daughter and grandchildren.

The hospital offered her husband condolences and a bill for $750,000.

"What we should do is require people on Medicare to compile a living will, with specific instructions. What Palin mendaciously called "death panels." The thing is, many, many people would rather not be kept alive under all circumstances. But outside valid instructions, or a suitable, knowledgable health proxy, the default is "keep alive.""

The problem with this is twofold:

1) That nasty tort reform issue, if one person who MAY have standing objects to end of life procedures the doctors and hospital always err on the side of maintaining life for fear of getting sued.

2) The basic mind set of Americans. No I don't have a study. But we tend to think of end of life just like the doctors, as a defeat.

As long as there is a chance that we can score that last minute touchdown, get the onside kick, throw the hail mary, convert the two point conversion and push the game into overtime we are required to keep playing. In almost every cultural norm that is what we are taught. End of life happens only when it is the final option, meaning it happens against all attempts to delay it. It is the reason for many good things in our culture, this is one of the challenges it creates.

That nasty tort reform issue, if one person who MAY have standing objects to end of life procedures the doctors and hospital always err on the side of maintaining life for fear of getting sued.

This is true absent a living will or health proxy by written instrument. In such settings, hospitals will honor the wishes of the patient/proxy over objections because the patient's/proxy's word trumps.

But you are right absent a living will/proxy. That being said, the problem wouldn't likely be solved by "tort reform" unless you mean a very drastic form of reform such as you would do away with most suits for negligence. But fear of valid lawsuits applies. And you're right about the cultural norm.

But that's why it is important to have the living wills and health proxies. Many will still opt for "keep alive at all costs" but many would not. Further, minds change when you're in the midst of the pain/suffering.

My father had a massive heart attack 8 years ago (quad bypass followed) and they had to use a defib to resuscitate him and he was subjected to many painful procedures with a long recovery time. After that, he changed his mind, drafted a living will and pretty much asked for DNR (do not resuscitate) in a whole host of settings.

Adding, Marty, that disregarding a living will would open the hospital up to liability as well. And a living will, if drafted correctly, provides serious protection for the hospital to act without liability.

That nasty tort reform issue, if one person who MAY have standing objects to end of life procedures the doctors and hospital always err on the side of maintaining life for fear of getting sued.

Yes, but as you right-wing tort-reformers always ignore, the most effective form of tort reform is universal health care, free at point of access. That you don't even want to consider this, tells me that you don't want tort reform: on the US politics gameshow, it's just another Call My Bluff word, for which you have made up your own definition to score points.

(I think for right-wingers the Call My Bluff definition of tort reform is: Poor people should not be able to get large sums of money by sueing rich people (including corporations) no matter how badly wronged or harmed the poor person has been.)

I am really tired of you twisting and kvetching at everything I say endlessly and needlessly with no point.

Well, Marty, you could try being honest and straightforward, citing facts instead of making wild assertions. For example, that you kept trying to build on a meaningless comparison of data about Canadian waiting times with your own imaginary US waiting times. But if you're sorry you did that and you won't do it again, well, I'll await your next data-less assertion with interest...

And if you really just meant to share a story about your Dad, not try to make a point about US healthcare, you really needed to edit the words "I am not sure the US, in this particular only, is that far behind" out of your anecdote about the regular checkups your dad receives. But if you just forgot to hit preview and didn't realize that line was still in there, well, we've all made that mistake once in a while.

"Adding, Marty, that disregarding a living will would open the hospital up to liability as well. And a living will, if drafted correctly, provides serious protection for the hospital to act without liability."

It is true that it provides great protection and specificc guidance, I agree that it is an essential step forward. I watched as my grandfathers living will was ignored (so to speak) because a relative was vocal in questioning the interpretation. Which is a reason for specificity in living wills, not an argument against them. More difficult is medical proxy, which tends to provide for the person to work with the professionals to interpret the living will. I am not an expert but have had several occasions (father, mother, grandfather) over the last several years to watch the emotional drama of that decision making process. As an aside, both my mother and father have a great quality of life after being at the point where the doctors had to ask if they should be revived in the last few years. Neither wished that someone would have chosen differently. My grandfather probably lingered a year longer than he would have chosen because of the family's emotional direction to the care providers.

It is not an easy area to discuss, I try to be very sensitive to peoples emotional responses while also trying to assimilate the more academic or intellectual responses.

"(I think for right-wingers the Call My Bluff definition of tort reform is: Poor people should not be able to get large sums of money by sueing rich people (including corporations) no matter how badly wronged or harmed the poor person has been.)"

I think the Call my bluff definition for jes is "can I disparage as many target people as possible by making inane and obviously untrue generalizations".

Yeah, I agree Marty. More specificity, and clear instructions to the proxy are the best bet.

Not only does that serve the patient best, but also the next of kin who sure don't want to be doing any guessing.

And as Seb said, in general we as a nation should be considering these issues more than we are.

"Yes, but as you right-wing tort-reformers always ignore, the most effective form of tort reform is universal health care, free at point of access. "

And just so I am clear, are you for or against an NHS type health care system in the US? I wish you would be clearer about that.

It would be so much easier to have discussions about what could or might happen, the real alternatives on the table and the view of most Americans tha an NHS style system is not the right answer if only we understood better where you were coming from because starting and ending every conversation with "that would be solved in an NHS system" is not productive in the context of healthcare reform in the US.

It is a lot like Republicans saying that everything could be fixed by tax cuts(or eveen tort reform), even if its true it isn't going to happen.

And

(I think for right-wingers the Call My Bluff definition of tort reform is: Poor people should not be able to get large sums of money by sueing rich people (including corporations) no matter how badly wronged or harmed the poor person has been.)

And I am extremely disappointed to hear that doctors can't be sued for malpractice in the UK because it's too bad that poor people can't sue the government no matter how badly wronged they were. That is what you mean by tort reform being solved by NHS, right?

Marty: It would be so much easier to have discussions about what could or might happen

It would be so much easier to have discussions about what could or might happen if you, and your allies, would stick to citing facts rather than wishful thinking.

If you want to argue realistically about the US health care system, you first need to be able to base your realistic arguments on real data. Thus far, on this thread, you haven't been able to do that.

I agree it's unrealistic to suppose that a national health service could be set up in the US, because although it would clearly be extremely popular with the majority of voters, your system of government is to give priority to the needs of corporations over the will of voters or the needs of human beings.

But so long as you feel free to disrupt serious realistic discussion about health care with your own imaginative assertions without reference to the real world, you really have no high moral ground to complain that I'm disrupting discussion by pointing out how much better off Americans would be if you, like us, had adopted a universal socialist health care system in the wake of WWII.

That is what you mean by tort reform being solved by NHS, right?

A while ago when a Republican brought up the shibboleth of "tort reform", I noted:

One reason why Americans are more litigious over things where a neutral point of view says no one is really "to blame" - because accidents happen - is because the US does not have a national health care system, and health care insurers have a profitable habit of denying insurance to people with expensive health care needs.

If a doctor makes a mistake, and harms a patient, and the patient from then on has expensive health care needs, in the US system, it doesn't matter if the mistake wasn't the result of malice or incompetence on the part of the doctor: the patient has got to sue the doctor for malpractice in order to get the money the patient will need from then on in order to get the healthcare they require.

In the UK, because we have the NHS, a patient who is harmed by a doctor can afford to wait and see how far they feel the doctor was to blame, how much blame the doctor should carry, if the doctor is likely to repeat the mistake.

Suits have been avoided, in the NHS, when the doctor admitted the mistake to the patient, apologised to the patient, the hospital/Trust and the doctor explained the circumstances, and told the patient she or he was free to sue if they wanted to. But the patient was not at any point at risk of losing their healthcare or getting worse healthcare or having to declare bankruptcy because their healthcare bills had got too large to pay, or being forbidden to declare bankruptcy because it's illegal to do so for healthcare debt, or any one of the myriad things that the US healthcare system causes.

That is what I meant. Sorry you didn't understand me.

Marty, please provide a citation for your assertion that people can't sue for malpractice in the U.K. under the NHS?

http://www.loc.gov/law/help/medical-malpractice-liability/uk.php>This library of congress article suggests that the NHS accepts liability for negligence of its employees and will settle suits.

Furthermore this site describes the options, including litigation, open to U.K. residents for filing a malpractice or negligence claim with the NHS.

Dunno how you like to prepare it, but Cooks Illustrated has a recipe for cream-braised cabbage with lemons and shallots that's heavenly (albeit a bit indulgent).

That sounds different! I'll give it a try, if I can find it.

As a garlic loving Italian, I like my cabbage with garlic and olive oil. Although I also add red pepper to the cabbage. For variety's sake.

At the risk of being obvious, nothing is as good with cabbage as bacon. I'm still recovering from the first fried cabbage recipe I tried (which, believe it or not, called for a full pound of bacon per cabbage head, then you fry the cabbage in the grease). Last iteration I went to half a pound of bacon, and threw away about 3/4 of the grease; next time I think a quarter pound of bacon and even a bit less grease would work wonders. Oh, and red pepper flakes with a bit of Creole seasoning, just to give it a bit of zing.

I'm obviously not worrying about BMI, at present. The bacon does complement the cabbage quite nicely, though.

Another of my favorite recipes involves cutting turnips into thin wedges and sauteeing them in olive oil and fresh thyme, letting them braise for a while and then finishing them off with a little triple sec.

You'll never want to do turnips any other way.

Another of my favorite recipes involves cutting turnips into thin wedges and sauteeing them in olive oil and fresh thyme, letting them braise for a while and then finishing them off with a little triple sec.

Okay, but first you have to define "turnip" - is it this or this or this?

"One reason why Americans are more litigious over things where a neutral point of view says no one is really "to blame" - because accidents happen - is because the US does not have a national health care system,........"

So your point is that in Britain people just don't sue for pain and suffering or lost wages? Since their healthcare is covered they simply don't sue?

As a tort reform advocate I would never suggest limiting out of pocket medical expenses, lost wages or cost of medical insurance/care that can no longer be obtained. In fact, I would like to pass a law saying that is automatically awarded based on a formula so litigation is not necessary.

I would prefer that there be a cap on pain and suffering awards.

See, I am not sure how that translates to those right wingers wanting the poor to not be able to take money from those rich people.

"Marty, please provide a citation for your assertion that people can't sue for malpractice in the U.K. under the NHS?"

I didn't assert this

So your point is that in Britain people just don't sue for pain and suffering or lost wages? Since their healthcare is covered they simply don't sue?

No, Marty, that wasn't my point.

In fact, I would like to pass a law saying that is automatically awarded based on a formula so litigation is not necessary.

Okay, so the best means of making sure that "out of pocket medical expenses ... cost of medical insurance/care" can be obtained without litigation, would be... a national health care service.

And that was my point.

"It would be so much easier to have discussions about what could or might happen if you, and your allies, would stick to citing facts rather than wishful thinking"

You mean like "I wish we could have NHS and that people really wanted that?"

I am more and more intrigued by your exceptionalist view of the NHS. It is practically American in it's zealous defense and constant reaffirmation of its superiority.

It is as if you don't believe that, given anyone really cared, the internet is not full of the pros and cons of the system, its challenges and faults, and the discussions of privatizing it in every election cycle.

Of course the difference is i wouldn't pretend it to be worth my while to try to tell you what Brits wanted or didn't want.

It is funny also to read your defenses of the Canadian system that I clearly have more experience with than you.

What is most clear is that you need and want something, anything, to criticize the US about. Healthcare, the military, the very form of government. I believe this must be your reaction to your feelings of cultural inadequacy. This inadequacy makes it impossible for you to recognize any good or strength in the US and constantly harp on the samae issues over and over, calling people names and, in general, just being negative.

Or you just don't like me, but from what I have observed, it isn't that personal.

"Okay, so the best means of making sure that "out of pocket medical expenses ... cost of medical insurance/care" can be obtained without litigation, would be... a national health care service."

Which i suspect is not really the biggest issue to be resolved from a cost saving perspective, which is what I was saying.

Okay, but first you have to define "turnip"

I suggest purple-top turnips, of the kind that is (apparently) shown in the first of your links, but smaller if possible. Around 7cm diameter would be a better size, I think.

I haven't tried any other kind of turnip; for all I know other varieties would prepare well this way.

If you want, I can get you the exact recipe. It's in a Williams-Sonoma cookbook that we've had forever.

What is most clear is that you need and want something, anything, to criticize the US about. Healthcare, the military, the very form of government. I believe this must be your reaction to your feelings of cultural inadequacy.

This is good stuff, the wikipedia article on "projection" needed some new material.

I am more and more intrigued by your exceptionalist view of the NHS. It is practically American in it's zealous defense and constant reaffirmation of its superiority.

This is even better- American exceptionalism so strong that just plain doesn't grasp other countries' citizens feeling the same way. "It's so cute how you pretend to love your country as much as we Americans actually love America. You probably act that way because you're jealous."

It is funny also to read your defenses of the Canadian system that I clearly have more experience with than you.

So far, your 'clear experience' is demonstrated via some statistics from the internet that were interpreted badly (ie claiming that average wait times applied to the subset of people with serious conditions). Oh, and a couple of claims that you knew a lot about it.

Carleton,

I would prefer to deal with one troll at a time. I am happy to have any level of conversation or take any level of criticism, yours or anyone elses, if you want to disuss anything in good faith, even whether I am discussing things in good faith.

However, if i typed that the sky was blue today where I am, jes would find a way to tell me I am wrong, the solution is the NHS, the US government is a beta democracy and that I am a right wing (pick your epithet).

For months i just ignored her, but I shouldn't have to ignore someone constantly calling me names just on the edge of the posting rules.

So ease up while I deal with a much longer standing problem.

Marty: I would prefer to deal with one troll at a time.

Physician, heal thyself.

"Physician, heal thyself."

Well, I am disappointed yet not surprised at this response. I can go over and try to be the voice of reason at a place like RedState or I can try to have a moderate voice on a site like OBWi.

The problem is that in neither place doe sanyone want to see the world from the otherr sides point of view. Despite the histrionics of health care and the waars and essentilly everything we discuss there are two or more points of view.

It is interesting whether it is the pure vile of some websites or the constant drone of attack here that it is clear that everyone wants a nice side to come and just beat up the other guys.

I can sit at home and talk to myself if all I want is to trash the other side and then agree with myself so I feel better, and really smart.

I do this because I think having both sets of ideas in a thread is good for me, and possibly others. I get and give criticsm pretty well. What Jes does is not that, i certainly have waited a long time to exxpress that, I won't again, but it is easy to read through this thread and find the classic example.

lj said "on this side of the Pacific" and then told an interesting anecdote that informed, I said :Iam not sure America is far behind in this instance" and told what I thought was interesting anecdote that was quite similar. Jes attacked me...not lj, not the discussion, she found a way to make what I said bad.

Its what she does.

Can I just call a timeout, and ask that everyone (myself included) try to take a breath and return to a more respectful tone.

Myself included - to reiterate.

Good with me

Can I just call a timeout, and ask that everyone (myself included) try to take a breath and return to a more respectful tone.

How about an open thread so Slarti can share his turnip recipe?

"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

Russell, this is a fairly broad restriction limiting the Federal Government to those powers enumerated in the Constitution which include, apparently to the chagrin of numerous commenters here, the authority to use military force to defend the United States against foreign enemies. But I cannot find anything that I could conceivably construe to include taking over the direct provision of medical insurance to all inhabitants of the U.S. or the direct provision of medical services to all its people.

If I were able to find such construction as allowed these matters, then I would be at a loss to find the point at which this separation of powers actually has meaning.

Of course, the Constitution includes provisions for amendments and that would represent an appropriate path for the efforts of those who think the federal government having these powers is the solution to our health care needs.

Marty,
Apologies for this pile on, but the purpose of my anecdote was to open a discussion of what is needed to improve end of life care and given that Japan has the most population that is most rapidly skewing towards the higher end of the scale, I thought that my anecdote might be useful. I, of course, don't know the purpose of your anecdote, but it certainly seems as if you wanted to claim that the US had no problems. My anecdote pointed to a fully articulated system for all (or at least most, homelessness is becoming a problem here), whereas yours merely pointed to the fact that your father was in a position to get regular checkups. As such, it doesn't really get at what I was trying to point up. If there is some sort of nationwide system, or even statewide system, for dealing with elderly, I would love to hear about it, but arguing that you were simply presenting an anecdote to my anecdote really seems to miss the point of presenting the anecdote. I, of course, take full responsibility for this, but I would futher observe that if you view this as like a snowball fight, and the person who throws the most anecdotes wins, discussions are going the descend in quality in a similar way. Again, this is just an observation, but I only bring it up because you gave my anecdote as an example and I was perhaps not clear about the purpose for bringing it up. Again, apologies for the misunderstanding.

Russell, this is a fairly broad restriction limiting the Federal Government to those powers enumerated in the Constitution which include, apparently to the chagrin of numerous commenters here, the authority to use military force to defend the United States against foreign enemies.

Wow. A few minutes after a call for respectful tone, and this? Really? I mean, which commenters exactly rue the fact that the Constitution gives the executive power to defend against foreign enemies?

But I cannot find anything that I could conceivably construe to include taking over the direct provision of medical insurance to all inhabitants of the U.S. or the direct provision of medical services to all its people.

Well, then, it's a good thing that the Senate bill doesn't actually do any of those things. Not even close.

Wow. A few minutes after a call for respectful tone, and this? Really? I mean, which commenters exactly rue the fact that the Constitution gives the executive power to defend against foreign enemies?

The same ones who hate teh capitalism and eat puppies (mmm, puppies *Homerdroolz*)?

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