Your point about “fixed costs” is something you’re particularly fond of, but happens to be a blip in the real story of the difference between U.S. and European healthcare systems. We’ve already heard how European populations are generally healthier, so may require less “SWAT-team” medical care, fewer MRI machines, etc. But that is not the source of the higher costs of U.S. care.

U.S. physicians earn roughly twice what the Europeans do and have strict controls on the number of medical schools to keep the shortage of physicians constant. This is the AMA’s version of “managed” care. Also: Insurance companies in the U.S. spend a lot of time and money trying to eliminate potentially unhealthy patients from those they insure. Their overhead is something like eight times higher than the Europeans, as a consequence.

The idea of overbuilt hospitals in the U.S. is not foreign to me, either. For example, Oral Roberts attempted to build a medical school and hospital in Tulsa, despite the other hospitals having more than enough beds. He was private, so he got his way. I think the med school and hospital are now shut down. Oral had difficulty recruiting faculty willing to tow the party line that praying over patients was equivalent to medical treatment. I couldn’t make it up.

It doesn’t matter HOW many people use the system because the expenses are already incurred.

SInce you are dense we have to make this simple. You build a hospital that has 500 beds. In the hospital you have some x-ray equipment, a MRI, and other diagnostic tools. YOu build a few operating rooms, an obstectricts ward, etc, etc, etc……THen, you staff this hospital with doctors, nurses, technicians, administrative support, and other employees.

WHen you are done it lets say it cost $100 million and your annual staff costs are $10 million. The money is spent.

Now, that money is spent whether 0 people come into the hospital or 100,000 come into the hospital. THe fact that I “charge” you for your visit is simply the allocation of the fixed cost of my $100 million investment and $10 million annual operating cost. The amount I charge you is simply an allocation of this cost.

The only way to reduce the cost is to eliminate the fixed overhead, which is most of the cost. That is, the hospital can shut down or reduce services (meaning less staff and thus less service). That is the only options that are available.

You’re seriously suggesting that there WILL NOT be greater inflation in the future than we’ve become accustomed to, simply because Greenspan told us that we would ???

That’s extra-funny because WE’RE ALREADY FEELING THE EFFECTS OF MUCH HIGHER INFLATION !!!

Thus you’re saying that we should take with an extra-large grain of salt a prognostication that’s manifesting even as we type.

As to the rest…
I’d love to respond, but don’t have time. Sorry.

How about the cost of excluding less-healthy or older people from insurance coverage? That, and health insurance plan profits and multi-million-dollar CEO salaries is the biggest difference between private and public health care, I’d bet.

Poster Solar Lad quotes Greenspan. I suggest you read Ravi Batra’s “Greenspan’s Fraud” before you take anything the maestro says without an extra-large grain of salt. Greenspan’s agenda was to tax the poor so the rich could prosper. He (and Reagan, & Bushes) succeeded too.

These are normalized also in the WHO study so that inter-country comparisons are valid. But of course poster Mark believes that the WHO gets some kind of prize for promoting socialized medicine and Pfizer doesn’t get anything for promoting Vioxx, so overall measures are inferior indicators of health care.

According to him, the best measures are therefore comparisons of different countries as they treat individual diseases. France doesn’t treat warts as well as the U.S., therefore it has worse healthcare. OK, he said “cancer,” not “warts,” but the principle is the same.

I’ve had a little time to reflect about that mentality, and believe I’ve finally understood some of it. Thank you poster Mark! (Really)

It’s internally consistent to say that medical treatment in the U.S. is superior even if the population is sicker. France has fewer deaths from cancer, overall, but the U.S. has better treatments once you get cancer. So its population has plenty of chronic health problems, but, like health care commandos, the U.S. medical care system can swoop down and destroy any illness that dares become acute. We’ll just ignore what happens to the 40 million without health insurance, shall we?

Naturally the medical commandos will have more, and more elaborate equipment. They will have prozac, an excellent, if expensive, anti-depressant drug with side effects that is no better than exercise. Exercise is cheaper, has no side effects but better health… But the health care commandos will have superior anti-depressants to the poor primitives who deign to walk so they can stay healthy.

It’s even internally consistent to say that U.S. public policy that allows less-than-healthy food on the market at what amounts to subsidized, lower prices and that is a form of “wealth.”

This reminds me of an old Volkswagen I owned. Overall, it was incredibly unreliable, but it was also very easy to fix. I got rid of that car in a hurry rather than invest in my mechanical education.

So Mark’s position is consistent, but (IMHO) nuts. My choice is public policy that is not so focussed on ensuring big profits for Pfizer, McDonalds, ADM and Cargill, and produces better general public health, even if it can’t cure the less-frequently-occurring cancers as well. I don’t think there’s anything more to say about this.

Sincerely, though, Mark, thanks for clarifying your thinking about this stuff. I really hadn’t understood how cleverly the matrix worked previously.

Meanwhile, poster Solar Lad weighs in debunking many of my other misconceptions

About Social Security he says: The Boomers have violated their social contract regarding retirement “by not saving enough for their pending retirement. They could have done this in one or both of two ways:
“A) They could have invested heavily in private savings and retirement funds. That they didn’t do so is regrettable but not unexpected; it’s human nature to put off making a sacrifice that won’t pay off for decades.
“B) They could have used the power of their collective vote to demand a balanced Federal budget, so that when they retired, the gov’t wouldn’t already be trillions of dollars in the hole, and would be able to easily borrow more trillions to fund the Boomers’ retirement. But no, the Boomers wanted to enjoy a luxurious array of services now, whilst not paying for them.”

Yoshidad says: This is monumentally misguided, and hilarious (“luxurious array of services” in a country whose arts budget is exceeded by the City of Berlin amused me, at least). And yes, arts spending is orders of magnitude higher, but so are many other things. Here’s a quote that really demonstrates this in spades, IMHO:

“Can America send a man to the moon? Check. Build a swift, stealthy bomber that can evade radar in pursuit of enemies? Check. Write creative software that will fish through billions of bytes and pull out relevant few facts? Check.
But can America routinely build light, airy bridges that cross streams or gorges beautifully and sturdily, like Germany? Build high speed train lines like France, or giant gates that shut out the sea, like Holland? Set up a universal tolling system that allows trucks to travel without using toll gates, like Switzerland?
So far, the answer is ‘No,’ or at least, ‘Not yet.’

“…In Louisiana, the failure to spend around $10 billion to strengthen levees and control the Mississippi River means that the federal government is now contemplating spending up to $200 billion to rebuild New Orleans and other affected areas. And this doesn’t include the huge costs that insurance companies and private businesses and residents will incur.” – from Alex Marshall’s “Our Infrastructure Gap”

Notice, BTW, how consistent the U.S. is in its preference for battlefield medicine, the conquest of space, and the war on drugs. We’re drunk with military metaphors, whether in aerospace or health care.

Back to Social Security: First of all, Social Security is an insurance policy, not a savings account. The current wage-earning generation transfers part of its income to the retirees (and some widows and orphans), so savings play really no role in this at all.

(Note: There’s a slight exception for the Reagan / Greenspan social security tax increases that I’ll get to in a minute, but I’m mostly speaking truth here. You probably remember the savings that was the Social Security “lock box”…)

In fact, the recent (Bush) moves to privatize Social Security would not have worked because Social Security is a program of transfer payments rather than savings. A scheme like Bush’s vague “privatization” cannot answer this question: “If we start setting money aside in private savings (to invest in the stock market!) then where does the money that would pay the currently retired older generation come from, if not in even higher taxes?”

The whole proposal was a scam, perpetrated to break one of the genuine successes of the New Deal — Social Security. Here’s an elaboration of this point: http://www.rollingstone.com/politics/story/6822964/the_fake_crisis/

The actual origin of the social security, and many other problems, was not the Boomer’s lack of investment foresight, or their unwillingness to forego their “lavish” (hahahaha!) public realm. It was the Reagan “tax cuts” which actually turn out to be transfers of tax burdens from the rich to the poor.

Reagan signed eight tax increases, and Mr. “Read My Lips” went back on his pledge to hold the line on new taxes and increased FICA taxes. This ultra-regressive tax increased fourfold as a consequence, and average people — Boomers included — had less money to save overall. Tracking the savings rates validates this, too, and exactly follows the course of those reduced progressive tax rates.

So no, my libertarian / “Conservative” brethren, lowering taxes did not increase economic activity enough to increase collections. The eras of highest economic activity coincide exactly with higher tax rates (92% in the 1950′s and 70% in the 1960′s)

Lowering taxes lowered revenues, so the social programs that were so “lavish” were squeezed even further. Incidentally the chronic state budget deficits rolling through the country now are directly related to the squeezed federal revenue sharing, not state spending or state taxes.

The pathetic American public realm was made even more pathetic by this squeeze. Think of those “lavish” bus stops you can see everywhere — a naked sign stuck in the gravel shoulder of the road with no sidewalks accessing it, and not even a bench to sit on while you wait for a bus that comes every three hours. Man, I’m just struck by the lavishness of it all, especially compared to those bad, bad Europeans. Ouch!

Remember too, that Reagan’s premise for lowering the upper tax brackets (70% down to 35%, if memory serves) was “Supply-Side” economics. His budget director David Stockman famously confessed that Supply Side economics (AKA “voodoo economics”) was just a pretext to lower the top rates. (Stockman was in the news recently, being led away in handcuffs, indicted for securities fraud. I couldn’t make it up.)

This lower-the-progressive-income-tax-raise-the-regressive-FICA move make perfect sense if you’re paying the top rates too. If you save 35% in income taxes, the money otherwise taxable is like an investment yielding 35% after tax — something that is by no means easy to find.

So, Solar Lad, you may blame the “Boomers” or the tooth fairy for the lower savings rate, or the “lavish” public realm, but the truth is something different. Incidentally, the first Boomer president was Clinton, and he left a federal budget surplus.

Your point about elites governing in Europe is fine, as far as it goes. Of course the best and brightest sign up for public service. But even the Wall St. Journal’s study says that the ambitious poor have a better chance at social mobility in Norway than the U.S. (my memory says the U.S. was 11th in such a ranking of social mobility). It doesn’t matter if the duke of Blah is in Parliament if his policies serve the general public rather than, say, General Electric.

Finally, the entire debate about taxes and spending is polluted by the irrelevance of those categories of consideration. All but 15% of federal spending is interest on national debt, social security and Medicare, and the military. Now I know you may believe the social programs are “lavish,” but I’d advise you to get real.

They’re not, especially compared to other countries’. It’s completely politically unrealistic to consider cutting them, too. I’ve heard “Don’t you let the Guv’mint touch my Medicare” from “conservatives,” but you can see the nonsense of that statement, surely.

So unless you want to shut down the Federal Courts, the mint, and the Centers for Disease control, stopping that “lavish” spending is a non-starter. The programs have been squeezed so much that there’s nothing more to cut unless you want to close things that are necessary (the FBI?)… And you’ll *never* see a “conservative” proposal to cut anything significant. Even all the earmarks added together are a tiny percentage (1%?) of the total Federal budget.

So what’s the real story? When industry gets a free ride (the depletion allowance for petroleum), or an enormous subsidy (1031 exchanges for real estate), that’s far more important than taxes or spending. Neither of these show up on the P&L for the government, either. Read David Cay Johnston’s “Free Lunch,” if you don’t believe me.

Meanwhile, back in Europe, I apparently “think that forcing people to pay for purported “art” is a good idea.” Nope. I think allowing the majority of the population who understands that it’s cheaper (both individually, and to society as a whole) to build a public swimming pool than to require everyone who wants to swim to build their own — allowing that majority to determine public policy is a good thing.

But don’t take my word for it: Go to Europe and ask the people whether they’d give up their socialized health care system, or their concerts in the park. They *want* it. They want it enough to favor it as a public policy and vote for it. They want the public policy that includes pooling their resources. There’s nothing wrong with that. It’s called the “consent of the governed”… In the U.S., a small enough portion of the population votes that you can’t really say even that Reagan’s policies have that level of consent.

Incidentally, I’d say that larger American homes come from the public policy decision to allow home mortgage interest write offs. See what would happen without that bit of off-books subsidy, or the subsidy for stadiums. Or what about the subsidy (again off-books) of allowing sports to have monopolies. In London, they have 13 soccer teams, but in America, the sports teams can blackmail the cities (see the incredible con game Al Davis ran on Oakland and Anaheim, for just one of many, many examples).

I’m guessing you won’t agree. Do I win my bet?

Really? Then why were Spanish truckers able to effectively shut down the Spanish economy by refusing to transport goods, to the point where thousands of Spanish police ended up escorting convoys of food and fuel trucks, to ensure that common Spaniards were able to get the basics ?

If there were indeed “an alternative infrastructure of transit”, then striking truckers shouldn’t have been a big deal, right ?

Also, while listing the myriad ways in which the clearly-superior Europeans are living in Utopia, you forgot to mention that the average European family lives in cramped apartments that are less than HALF of the square footage that the average American enjoys.

Apparently when the government is not controlled by a small elite oligarchy…

Yeah? You’re claiming that the leaders of Spain, the UK, Italy, and especially France, to name a few, are NOT drawn from the elite ?!?!?

Perhaps you should brush up on your current European history…

Further, you appear to be asserting that America is “controlled by a small elite oligarchy”, but was Bill Clinton an elite oligarchist before being elected ?

Is Mike Huckabee, who made a strong run for the GOP nomination, an elite oligarchist ?

Is the likely next President of the United States, Barack Hussein Obama, an elite oligarchist ??????

All of them grew up in working-class families without political connections.

…let a poor non-ideologically-inclined person try.

LOL

C’mon, Yoshidad, although I disagree with you about almost everything, I respect you enough to believe that you have more self-knowledge than that. It’s like calling NPR “non-ideologically-inclined”.

For example, you posted “True fact: The arts budget for the City of Berlin exceeds the U.S.’ National Endowment for the Arts for the entire country. I couldn’t make it up.” That you think that forcing people to pay for purported “art” is a good idea, speaks volumes.

Take Social Security. Social Security is based on a bond among people. If you earn a salary today [...], you’re paying for the welfare and survival of your parents’ generation.

Ah, but what if one party violates the contract ?

Which is what the Boomers have done by not saving enough for their pending retirement. They could have done this in one or both of two ways:

A) They could have invested heavily in private savings and retirement funds. That they didn’t do so is regrettable but not unexpected; it’s human nature to put off making a sacrifice that won’t pay off for decades.

B) They could have used the power of their collective vote to demand a balanced Federal budget, so that when they retired, the gov’t wouldn’t already be trillions of dollars in the hole, and would be able to easily borrow more trillions to fund the Boomers’ retirement. But no, the Boomers wanted to enjoy a luxurious array of services now, whilst not paying for them.

By doing neither of those things, the Boomers are effectively saying to later generations “give up 20% of your wages to let us live in a style which we think we deserve, plus pay the normal 20% to fund everything else, and oh yeah, forget about being able to save for your own retirement.”

Well, that’s a lousy deal, and the Boomers are delusional if they think that future workers are going to put up with it until the last Boomer is in the ground.

No, I brought up cancer SURVIVAL RATES, a much different measure. Cancer “rates” or the proportion of the population that suffers cancer is independent of the health care system.

Again, your consistent utilization to such general statistics as “Life Expectency” weaken your case rather than supports it. The higher infant mortality rate in the United States, as I explained earlier, actually demonstrates the superior quality of the United States health care system because the US has more live births of at risk children than other countries because we have the technology and capacity for these children to survive. Other nations simply abort these problems away.

And, a great deal of the illness in our society can be explained by diet, as you alluded to. HOwever, part of this issue is that in general Americans are richer than other countries and have access to a diet that is not as healthy. This does cause health problems, and that is for sure. But that is not the argument that we were on. You have simply shifted the argument. In other words, that the US is healthier or less healthy of a country is an independent argument over socializing the health care system.

“[Yoshidad said previously]“Notice that U.S. cancer (death) rates exceed those of France, Finland, etc. which have socialized medicine — although, in fairness, U.S. rates are less than average.”

> Mark says: But that has nothing to do with medicine. That is exactly why “LIfe Expectency” [sic] is such a bogus value to use for measuring the efficiency [!] of the health care system.”

Mark, *YOU* are the one who brought up cancer rates, but when I demonstrated to you that those cancer rates (not the cure rates, but the deaths from cancer) were lower in the countries whose health care was socialized, you insist this has nothing to do with medicine. Well, OK, if that’s what you believe is the point of this discussion. I’d say I’ll take a healthier population over fancier medical care any day, but OK…

BTW, This makes you a perfect customer for the U.S.’ pharmaceutical industry. Recent studies show that exercise has all of the benefits of anti-depressants, without any of the side effects or the expense. Hearing this, I can guess you’d say “See, the U.S. has better anti-depressants than the Europeans who haven’t built walking out of their cities.”

And you’d be *right*. You wouldn’t have the satisfaction of a healthier population. You’d have a bunch of impoverished anti-depressant-taking zombies roaming around, experiencing side effects, and some wealthy pharmaceutical companies.

This is the contrast between being right and being satisfied.

So you’re not disputing that the U.S. population is sicker, overall. You apparently believe better treatments that still don’t let the population’s overall health catch up to healthier populations means that we’re winning some kind of battle against illness. I beg to differ.

This is germane in the conversation about agriculture too. No, agriculture isn’t medicine, but it’s part of a comprehensive approach to health, as it happens also pursued in European public policy.

U.S. agricultural subsidies produce high fructose corn syrup-a-plenty, and have gradually made food cheaper and more petroleum-dependent since the sixties, but with more junk calories. That’s the U.S. health / agriculture combination. Prices are lower at McDonalds, but you’ll get sicker if you eat the food. (See “Super-Size Me”)

And this is the result of U.S. public policy. Forty percent of agricultural income is subsidy in the U.S. Unfortunately that gigantic bonus for Cargill and ADM has come at a price. Health care costs have been rising to more than compensate for the cheaper food.

If you don’t think food and health are related, then that’s fairly typical for a citizen of the U.S., but doesn’t make it true. I guess it’s a kind of peculiar tunnel vision.

This is also like the U.S. public policy that promotes building sprawl — which presents enormous obstacles to walking anywhere. Then exercise equipment manufacturers get to sell Stairmasters to make up for the exercise of walking that people miss. The U.S. is still dealing with the epidemic of obesity and type II diabetes because of this clueless kind of city design. Your comment would probably be: “Yeah, but the U.S. has better Stairmasters!” Kind of a hollow victory, I say.

I say the object here is “having a healthier population,” not “having fancier MRI machinery that can swoop in and save a much sicker patient than would appear in Europe.”

So perhaps they have less fixed costs in Europe because they don’t need the hospital beds or fancy acute care equipment. What about that possibility? Hard to prove, either way, I’d guess.

FYI, Here’s a survey of life expectancy (death from all causes, not just cancer). Note that *all* of the countries whose citizens average longer lives are socialized medicine or socialized medical insurance.

Sorry for the hard-to-read format, I’ve had to make the columns wrap around, but the first one is Country, then life expectancy. You can figure out the rest:

Country Life expectancy
Infant mortality rate
Physicians per 1000 people
Nurses per 1000 people
Per capita expenditure on health (USD)
Healthcare costs as a
percent of GDP
% of government
revenue spent on health
% of health costs
paid by government
Australia 80.5 5.0 2.47 9.71 2,519 9.5 17.7 67.5
Canada 80.5 5.0 2.14 9.95 2,669 9.9 16.7 69.9
France 79.5 4.0 3.37 7.24 2,981 10.1 14.2 76.3
Germany 80.0 4.0 3.37 9.72 3,204 11.1 17.6 78.2
Japan 82.5 3.0 1.98 7.79 2,662 7.9 16.8 81.0
Sweden 80.5 3.0 3.28 10.24 3,149 9.4 13.6 85.2
UK 79.5 5.0 2.30 12.12 2,428 8.0 15.8 85.7
USA 77.5 6.0 2.56 9.37 5,711 15.2 18.5 44.6

(from http://www.answers.com/topic/health-care)

So anyway, I see your point: U.S. can do acute health care better than the Europeans, but the overall result is still worse (see life expectancy, or infant mortality, etc.).

Yes, I know the World Health Organization is an awful commie front with the agenda of promoting socialism everywhere, etc. But don’t you believe the pharmaceutical and HMO industries (not to mention the military industrial complex, ADM and Cargill, the prison industry, and the petroleum-auto complex) are at least this diligent in promoting their health-impairing agenda(s)?

Personally, I prefer the comprehensive bottom line approach to focusing on a single disease, in fact I think your approach is nuts, but that’s you’re thing.

So…you win the argument! And you get to die sooner…if that’s how you want to do it…8^)

But that has nothing to do with medicine. That is exactly why “LIfe Expectency” is such a bogus value to use for measuring the efficiency of the health care system.

“”fixed costs” … What on earth are those? Did you know French doctors will make house calls?”

LOL..I like it. THis statement clearly indicates that you have absolutely no knowledge of the health care system. IF you do not know what a fixed cost is, or cannot even imagine what the fixed costs are in the health care system you clearly cannot offer any insight. The fact that almost all of the cost of a health care system is fixed means you have no understanding of the economics. Think about it. And, the problem with fixed costs is that they exist whether you are treating patients or not. Health care economics is basically the allocation of these fixed cost.

Basically, the importance of this fact is that the only way you can reduce health care costs is to have less fixed investment. That means fewer hospital beds, fewer diagnostic machines, and fewer specialists. Even input factors that in most industries are variable cost are more fixed in the health care industry. That is, when you are hurt and injured you expect treatment, at least in the United States. This means that there needs to exist a high enough capacity of doctors, nurses, technicians, x-ray machines, emergengy room beds, and hospital beds, all equipped with the facility, skills, and drugs for whatever illness or injury you have.

The only way to reduce cost is to reduce capacity. This is what the Europeans do. Instead of getting treatment or diagnosis immediately you have to wait because they do not have the capacity to treat you. IT is cheaper, but clearly it is not as effective. THe end result, as we have seen, is that their treatments are less effective. When you have cancer you are more likely to die in Europe than in the United States, even for a cancer that in the United States has become routine like breast and prostate cancer (survival rates of over 90% in the United States). And, the fact is that you are going to suffer more pain because you will not be able to get a knee replacement or diagnosis/treatment for your injury as quickly.