Obamacare very successful, but still a long way to go

[Mountain Man]

Talking about quality of care, here's an old post of mine that I dug up from another forum showing that US is much better than the detractors say:

"On several measures, the NHS came out the worst of all the systems examined. For example, it ranked worst for five-year survival rates in cervical, breast and colon cancers. It was also worst for 30-day mortality rates after admission to a hospital for either hemorrhagic or ischemic stroke. On only one clinical measure was it best: the avoidance of amputation of the foot in diabetic gangrene.
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[…]
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"Traditionally, the NHS has been inexpensive compared with most healthcare systems. But this reality is changing quickly. The NHS was inexpensive in part because it rationed care by means of long waiting lists. I once had a patient who had waited seven years for a hernia operation. The surgery was repeatedly postponed so that a more urgent one might be performed."
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http://articles.latimes.com/2012/aug...ystem-20120808

(Jan 12, 2013) - "Seventeen NHS hospitals have dangerously low staffing levels, according to rulings by the official safety watchdog, it has been revealed. The hospitals, many of them busy district generals, were issued with warnings by the Care Quality Commission after its latest inspections, the body has disclosed.
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"Each was told it did not have enough staff 'to keep people safe and meet their health and welfare needs' — the standard every part of the health service must meet.
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"The English hospitals were named at a time of growing concern over the safety and dignity of NHS patients, with the report into the Stafford Hospital scandal due to be published in the next few weeks."
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http://www.telegraph.co.uk/health/he...of-nurses.html

"Official World Health Organization statistics show the U.S. lagging behind France in infant mortality rates — 6.7 per 1,000 live births vs. 3.8 for France. Halderman notes that in the U.S., any infant born that shows any sign of life for any length of time is considered a live birth. In France — in fact, in most of the European Union — any baby born before 26 weeks' gestation is not considered alive and therefore doesn't 'count' in reported infant mortality rates."
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http://news.investors.com/082609-504...ench-care-.htm

"Another comparison study showed that fewer Americans than UK residents die (per capita) from heart attack despite the far higher burden of risk factors in Americans for these fatal events. In fact, the heart disease mortality rate in England was 36 percent higher than that in the US. These superior outcomes from US medical care are particularly impressive, considering that American patients have far more risk factors (diabetes, obesity, chronic kidney disease) that worsen outcomes and death rates after heart attack and after heart surgery.
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"The US shows a far greater reduction in death rates from stroke, the third leading cause of death and the leading cause of disability in adults in the US and most Western European nations, than almost all Western European nations and the European Union overall.
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[...]
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"In a separate analysis of over 21,000 patients already visiting doctors for hypertension in five Western European nations (France, Germany, Italy, Spain, and the UK) and the US, the best rate of success was in the US (63 percent), compared with 31 percent to 46 percent of patients in the European countries. The facts show that more successful blood pressure control was seen in the US for both women and men under treatment, differences that are statistically significant.
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[...]
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"...a higher percentage of American diabetics than Canadian diabetics actually receive treatment. In the same WHO analysis, the US also performed best by several different quality measures, including blood glucose control, as well as effective management for all three key factors in diabetics (blood glucose, blood pressure, and blood cholesterol), approximately twice the success of England and Scotland. Here’s the bottom line: if you had diabetes, you were more likely to receive treatment and be treated successfully for the disease and the important risk factors for its serious sequelae in the US than in any other country studied.
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"Objectively, the world’s leading medical journals are filled with studies demonstrating the excellence of American medical care in comparison to other systems more heavily controlled by government bodies, the very systems held as models by those asserting the need for radical change to US health care."
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http://www.foxnews.com/opinion/2013/...d-doesnt-know/

For the record, all of these statistics are pre-Obamacare.

[shunyadragon]

That's because Obamacare requires people to get health care. Get health care, or pay a fine. That's not an ideal method of increasing the numbers. As you note, the costs keep going up. Obamacare is definitely not making health care more affordable. It does offer to help pay the costs somewhat for those who can't afford it, but that adds a cost for the government that will continue to increase; and the increasing cost will increase the government's budget deficit.

Of course, those costs would continue to increase without Obamacare. I don't want to get rid of the program. I like some of its features, such as making sure that people with pre-existing conditions can get health care. I'd like to see something added that makes the costs go down significantly. Republicans aren't helping by trying to scrap the whole thing rather than improving it.

Required universal health care regardless of form has been the best way you go. The Canadian system is an excellent example of success. Unfortunately our system is more complicated, and needs to simplified.

[Knowing Thomas]

A lot of people were very worried due to extensive fear-mongering that the Republicans engaged in. That fear-mongering has unsurprisingly turned out to have no basis in reality. A public apology from them would seem reasonable.

That certainly sounds familiar to the reaction to a certain law in Indiana.

[Bill the Cat]

Required universal health care regardless of form has been the best way you go. The Canadian system is an excellent example of success. Unfortunately our system is more complicated, and needs to simplified.

Ask Mossrose how successful the Canadian system is.

[Sam]

Talking about quality of care, here's an old post of mine that I dug up from another forum showing that US is much better than the detractors say:


For the record, all of these statistics are pre-Obamacare.

The United States lags behind many other developed nations in infant mortality even when one accounts for the different standards of reporting prior to 24 weeks.

Source: U.S. infant mortality rate worse than other countries. Tara Haelle. CBSNews.com. 2014/09/24

At the same time, it appears that more babies are born before 24 weeks in the United States than in other countries, MacDorman said.

"I think that we make greater efforts to save really tiny babies at 22 or 23 weeks than in some other countries," she said, although she added that the report didn't address the reasons for her team's findings.


"Whether that's a good thing or a bad thing, I think depends," MacDorman said. "We might have more of those tiny babies surviving, but they might survive with terrible disabilities, long-term health problems and so forth."


When her study team excluded births before 24 weeks, the U.S. rate improved to 4.2 deaths per 1,000 live births but still lagged behind nine other countries and remained about double that of Denmark, Finland and Sweden.


The infant mortality rate specifically among early preemies (24 to 31 weeks) was mostly similar in the United States and Europe, but the U.S. rate for babies born between 32 and 36 weeks was poorer. For babies born at 37 weeks or later, the United States ranked last.

© Copyright Original Source

A big part about reducing the number of infant deaths is (obviously) maternal and neonatal health coverage: both covered under the "essential benefits" mandate of the ACA, both available to millions more families now than before the ACA, and both targeted in the past by Conservative critics.

[Sam]

Ask Mossrose how successful the Canadian system is.

More satisfying that the U.S. health care system back in 2010:

satisfaction_vox_360.jpg

[Sam]

That certainly sounds familiar to the reaction to a certain law in Indiana.

The only thing that was very far off in the response to Indiana's RFRA was the fact that such discrimination was already perfectly legal in most of the state. The rest, especially the creation of an entirely new category of legal defense for discriminating private parties, was relatively accurate.

[Bill the Cat]

More satisfying that the U.S. health care system back in 2010:

[ATTACH=CONFIG]5859[/ATTACH]

Source: http://www.cdc.gov/nchs/data/nhis/jcush_analyticalreport.pdf

The top reasons for unmet health care needs differed between the two countries: waiting time was most often reported in Canada and cost was most often reported in the U.S.


When asked about their satisfaction with health care services in general, more Americans than Canadians reported that they were “very satisfied” (53% vs. 44%). Canadians were more likely to indicate that they were “somewhat satisfied” (43% vs. 37%). These differences remained when Canadians were compared with insured Americans.
Canadians were in fact more similar to uninsured Americans regarding satisfaction with care. The only significant difference between Canadians and uninsured Americans was the proportion reporting that they were “very dissatisfied” with their health care services: 9% of uninsured Americans and 3% of Canadians said they were very dissatisfied. (Table 7)
When asked specifically about satisfaction with physician services, insured Americans were more likely than Canadians to report that they were “very satisfied” (68% vs. 64%). (Table 7)

© Copyright Original Source

[Sam]

Source: http://www.cdc.gov/nchs/data/nhis/jcush_analyticalreport.pdf

The top reasons for unmet health care needs differed between the two countries: waiting time was most often reported in Canada and cost was most often reported in the U.S.


When asked about their satisfaction with health care services in general, more Americans than Canadians reported that they were “very satisfied” (53% vs. 44%). Canadians were more likely to indicate that they were “somewhat satisfied” (43% vs. 37%). These differences remained when Canadians were compared with insured Americans.
Canadians were in fact more similar to uninsured Americans regarding satisfaction with care. The only significant difference between Canadians and uninsured Americans was the proportion reporting that they were “very dissatisfied” with their health care services: 9% of uninsured Americans and 3% of Canadians said they were very dissatisfied. (Table 7)
When asked specifically about satisfaction with physician services, insured Americans were more likely than Canadians to report that they were “very satisfied” (68% vs. 64%). (Table 7)

© Copyright Original Source

You're responding to my graph of a 2010 survey with a analytical report from 2003?

[shunyadragon]

Ask Mossrose how successful the Canadian system is.

I go with my relatives in Canada who have lived for generations, also the fact that coverage is universal.

[Bill the Cat]

You're responding to my graph of a 2010 survey with a analytical report from 2003?

From a time well before Obamacare came into the mix, I showed that Americans were already much happier with their healthcare than Canadians. Yours showed in 2010 that Canadians were happier, which was after the Health Care and Education Reconciliation Act of 2010 passed by the Democrat controlled Congress. So, exactly HOW did Obamacare make American health care more satisfying than Canadian health care?

[Sam]

From a time well before Obamacare came into the mix, I showed that Americans were already much happier with their healthcare than Canadians. Yours showed in 2010 that Canadians were happier, which was after the Health Care and Education Reconciliation Act of 2010 passed by the Democrat controlled Congress. So, exactly HOW did Obamacare make American health care more satisfying than Canadian health care?

Americans weren't much happier than Canadians, if you read your reference. Americans with insurance were happier in 2003 but Americans lacking insurance were much unhappier (and unhealthier) than Canadians.

Source:

Canadians and Americans differed overall, however, regarding access to health care services provided under different insurance models such as those covering physician services. While Canadians are similar to insured Americans regarding access to a regular medical doctor and regarding unmet health care needs, they face significantly fewer barriers to care when compared with uninsured Americans.

The greatest differences between the two countries are related to differentials by income in health. While there has been solid evidence for some time of the social gradient in health status in both Canada and the United States,14 this is the first time that we have been able to examine the question of whether there are systematic differences in health status by social position in the two countries. One of the important findings of this survey is that Americans in the poorest income quintile report fair or poor health, obesity and severe mobility impairment more frequently than their Canadian counterparts. At the other end of the income spectrum, there are no systematic differences in the reporting of fair or poor health or mobility impairment among the most affluent households on either side of the border.

Image 004.jpg

© Copyright Original Source

And the only provision I can remember that directly affected healthcare consumers in 2010 was the provision allowing children to remain on parents' plans until they were 26, still a wildly popular provision. Trying to argue that satisfaction with the health care system in 2010 is a reflection of the ACA's effect on it is pretty dumb, to be blunt.

ETA: Also, I don't see anyone having said that the ACA made American health care more satisfying than Canadian health care. If anything, people have been arguing that higher satisfaction with Canada's more progressive system shows that the ACA hasn't gone far enough for all citizens, not just the ones that were lucky enough to have insurance in 2003.

[Starlight]

That certainly sounds familiar to the reaction to a certain law in Indiana.

I suggest you be a bit more careful about what sources of information you believe. Don't go buying into everything they tell you, and don't be suckered-in. Try getting your information from a few different sources for a more balanced/accurate perspective.

[Starlight]

More satisfying that the U.S. health care system back in 2010:

[ATTACH=CONFIG]5859[/ATTACH]

This seems to be reflective of the fact that Canada's system is one of the worse performers compared to some of the various other OECD countries with universal healthcare:



When you look at that chart, it's not surprising that the percentage of people in the UK who report being satisfied with their healthcare system is 1.5 times what it is in Canada.

So Americans who are comparing their own system with Canada's should probably bear in mind that they are seeing a particularly poor example of socialized healthcare in Canada compared to other countries. It's also worth noting that the Canadians are only paying around half of what Americans are paying for their healthcare.

[Starlight]

It is a straw man to claim that Christians "truly believe that letting the poor die is preferable to the government helping the poor". No Christian I know thinks in such black and white terms.

I understand that that's not necessarily how they would think about it or phrase it, but that is what the actual consequences of their position appear to be.

They think that the government helping the poor is bad, and would rather that the government didn't do it. Obviously the practical implications of getting rid of the government's nationwide coordinated system to help the poor, is that the poor become dependent on whatever local charities happen to exist in their area. If those charities are well-stocked and well-run by a large and enthusiastic team of people who are competent at what they do, then that's likely fine. But those in areas where poverty is rampant and where the local charities just can't meet the demand, either due to a lack of resources or competence, then the poor people are obviously going to suffer accordingly.

And there exists plenty of free clinics and emergency rooms to deal with basic medical care in order to survive. So, again, no one is interested in watching the poor die just to save a penny in taxes.

But those who are getting the free care only are clearly not getting the same level of medical care at all as those who pay for it. Clearly there is a big difference otherwise no one would pay for it. As I mentioned in the OP, various estimates have put the number of people who die in the US per year due to lack of healthcare at around 20,000 to 45,000 people. You seem to be implying those estimates are totally wrong because you're implying the correct number is zero people. Is that what you're saying?

Because of the fraud that costs the US $750 Million per year.

That's a tiny amount in terms of total government expenditure. To put that into perspective, it's 0.1% of the government's yearly spending on military. The amount of food stamp fraud could go up by one hundred times and it still wouldn't cost as much as a single war. The entire food stamp program only cost around 12% of total military spending.

There are lots of things that the government is wasting some serious money on, that are real drains on the economy, but food stamps is not one of those. It's false-economy to be trying too hard to save money on the small things when you're not worrying enough about saving money on the big things. Tricking people into thinking something minor is a problem seems to be a common tactic in US politics - we see a similar thing with the idea of "voter fraud" being a serious concern.

Perhaps you can link to Christian organizations who say that they are ok with starvation of a few in order to save a few tax dollars.

It seems that there's simply a failure to think about the logical consequences of their own positions.
Them: "We don't think the government should feed poor people."
Me: "Won't that mean the poor people starve to death?"
Them: "Private charities will step in."
Me: "So what happens in areas where there aren't sufficient charities to meet the need?"
Them: ...

We hate the government creating generations of dependents who choose not to excel because it will cause them to lose their "allowance". We hate that the government is rewarding lazy single mothers who keep churning out babies just to increase their amount of welfare.

Okay, those seem potentially legitimate concerns, and I agree that if there was sufficient evidence that that kind of thing was happening in large numbers, that would be a good reason to enact some small reforms in how the system is working.

What I've seen tend to happen though, is that a tiny handful of anecdotal cases of abuse of the system get widely shared, and there then grows a widespread desire to make major alterations to a system that was mostly working fine just to deal with a few minor edge-cases. It becomes a mentality of "we have to prevent 99 people who need assistance from getting it, because we're scared that 1 person who doesn't need assistance might also get it. But in our mind that 1 person has grown to 50% of the people, because we keep hearing about that 1 person over and over again."

Would you like if NZ passed a law that required you to serve 5 hours a month at a homeless shelter?

I would be quite happy with a law mandating a small amount of community service per month for everyone. That sounds like quite a good law to me for a number of reasons. It would bolster community spirit and give everyone a wider perspective on the society in which they live, which I think has become quite insular for a lot of people.

Or would you rather CHOOSE to work there out of compassion for the poor and with no legal prompting from the government?

I'd rather the government made everyone do it.

Which is more noble? The enforced or the voluntary?

I'd say the nobility of the act largely lies in the attitude with which it is performed. The fact that a person turns up for work at a homeless shelter, be it voluntarily or because it's government-mandated, doesn't strike me as being remotely as important as how they choose to treat the people they are working with, and to me the nobility of the situation lies in whether their actions toward others are filled with love, generosity and kindness or the lack of those.

Do you care why someone is poor, or do you, like the elitist left, just care that you get to be their hero and give them stuff for the unstated expectation of votes?

Of course I care why someone is poor. Your idea of the left just being in it for the votes doesn't make any sense, because if the left's only motivation to win their votes is so that it can pass policies that benefit those people, then that is pretty circular.

The left doesn't expect personal responsibility in any way from their voting bloc.

"Personal responsibility" strikes me as a rather callous way of ignoring biblical obligations to help the poor. Regardless of whether they are poor due to their "own fault" or not, the fact is that they are in poor and in need of assistance. The phrase "personal responsibility" seems just a nicer way of saying "I'm just going to let you suffer and do nothing to help!"

They like the idea of the poor getting help through private charities.

Which is the way the Bible says it should be.

No, it doesn't. There is absolutely nowhere in the bible where it says: "The way the poor should be helped is through private charities, not through government programs."

That's what I've been saying - your whole idea that the Bible mandates that charity be private and never government run is just totally delusional theology. It's not in the bible. It's just something that the religious right has invented out of whole cloth to oppose the welfare state with.

We expect some measure of responsibility in the program, not just a free-for-all to anyone who applies for it.

I'm perfectly happy with there being reasonable limits for eligibility for welfare programs.