"Rigid Class System in Europe" Bob Roll Comments

Simon Brooke wrote:
Gabe Brovedani ') wrote:
Robert Chung wrote:
http://jama.ama-assn.org/cgi/content/full/295/17/2037
http://care.diabetesjournals.org/cgi...full/26/4/1116

For those keeping score, that's one for the UK and one for Canada.

Are you suggesting the American revolution was a bad idea?

No, the idea was great. It was the execution that was stuffed...

You're confusing it with the French revolution. That was
the one with all the execution.

Ben

Pudd'nhead Wilson wrote:

What do you mean by "our problems?"

Bang for the buck. Poor value. On almost all objective measures of quality
of care, we do quite well: maybe not the best in the world but we're in
the middle of the rich countries of the world and that ain't a shabby
place to be. The place where we're not in the middle of the pack is in how
much we pay for that care.

Pudd'nhead Wilson wrote:
Ron Ruff wrote:
Jack Hollis wrote:
Life expectancy is not the measure of health care. It has some
effect, but there are so many other components that it's hard to tease
it out. There's a genetic component and diet and nutrition play a
role.

Good point! On the diet and nutrition, anyway. The fattening of the US
probably doesn't help.

The studies Robert pointed to didn't control for Supersizing.

The JAMA study controlled for BMI.

Jack Hollis wrote:

but every Canadian I've talked to (dozens) loves it!

Last survey I saw was 80% of Canadians are satisfied. Nevertheless,
there are still waiting lists, but nothing like what you see in
Britain.

And what was the corresponding number for Americans? The number I'm
familiar with was from Blendon's old 1990 article on public attitudes
toward their own country's health care system. In that study, about 10% of
US respondents were satisfied with their system.

in message , Robert Chung
') wrote:

Jack Hollis wrote:

but every Canadian I've talked to (dozens) loves it!

Last survey I saw was 80% of Canadians are satisfied. Nevertheless,
there are still waiting lists, but nothing like what you see in
Britain.

And what was the corresponding number for Americans? The number I'm
familiar with was from Blendon's old 1990 article on public attitudes
toward their own country's health care system. In that study, about 10%
of US respondents were satisfied with their system.

That doesn't necessarily mean it's worse. An American commentator
recently presented a very compelling argument on British television that
the reason British railways are so appalling is because we tolerate
appalling service and don't pressure the operators enough to improve it.

British railways are appalling. In my opinion the reason they're so bad
is because they're privatised; British Rail was poor, but not as
outrageously bad as the current mess, and the lack of any coherent
overall strategy is striking. The people who own the trains don't
operate them; the people who operate them don't own or control the
tracks; and the people who own the tracks don't maintain them.
Competing, sectional private interests conspire to prevent the effective
delivery of a public service - and this despite receiving far more
public subsidy than British Rail ever had.

But a few people are getting very rich, and it's the rich few who
bankroll the political parties, so not only will it not change but our
health service, which is actually very good by international standards,
looks like going the same way.

--
(Simon Brooke) http://www.jasmine.org.uk/~simon/
There's nae Gods, an there's precious few heroes
but there's plenty on the dole in th Land o th Leal;
And it's time now, tae sweep the future clear o
th lies o a past that we know wis never real.

Simon Brooke wrote:
in message , Robert Chung
') wrote:

Jack Hollis wrote:

but every Canadian I've talked to (dozens) loves it!

Last survey I saw was 80% of Canadians are satisfied. Nevertheless,
there are still waiting lists, but nothing like what you see in
Britain.

And what was the corresponding number for Americans? The number I'm
familiar with was from Blendon's old 1990 article on public attitudes
toward their own country's health care system. In that study, about 10%
of US respondents were satisfied with their system.

That doesn't necessarily mean it's worse. An American commentator
recently presented a very compelling argument on British television that
the reason British railways are so appalling is because we tolerate
appalling service and don't pressure the operators enough to improve it.

Right, I wasn't implying that satisfaction is a reliable metric. In fact,
I was citing an ancient study because I don't usually pay any attention to
satisfaction data so I'm not up-to-date on it.

I do, however, have a more appropriate example, even though it's an
anecdote. A friend was trying to demonstrate that patient satisfaction
surveys aren't terribly useful as an objective measure of quality of care.
He got permission to do in-depth interviews with women who had been
recently discharged after childbirth from a couple of hospitals in his
area. Almost everyone was very satisfied with their care, citing the
friendliness of the staff, the attractiveness of the rooms, the ability to
have their partners with them, that sort of thing. However, when he went
deeper into the interviews he uncovered nearly half who either had
themselves or whose babies had post-natal complications: almost all of
them were minor, but they were still conditions that could be linked to
sub-standard care. He gave a report to the hospitals' administrations. You
can see this coming: rather than taking this as evidence that patient
satisfaction doesn't capture all aspects of quality of care, the
administrations took it as a sign that they had been successful in getting
the staff to be friendly and that their room remodeling had been
successful.

On Fri, 25 Aug 2006 09:13:39 +0100, Simon Brooke
wrote:

And what was the corresponding number for Americans? The number I'm
familiar with was from Blendon's old 1990 article on public attitudes
toward their own country's health care system. In that study, about 10%
of US respondents were satisfied with their system.

That doesn't necessarily mean it's worse. An American commentator
recently presented a very compelling argument on British television that
the reason British railways are so appalling is because we tolerate
appalling service and don't pressure the operators enough to improve it.

Someone mentioned that all the Canadians he knew were satisfied. I
doubt that satisfaction is a very good measure of the quality of
health care.

Jack Hollis wrote:

Someone mentioned that all the Canadians he knew were satisfied. I
doubt that satisfaction is a very good measure of the quality of
health care.

Right, I already addressed that. What you've been avoiding assiduously are
the cross-national quality of care studies.

Robert Chung wrote:
Pudd'nhead Wilson wrote:

What do you mean by "our problems?"

Bang for the buck. Poor value. On almost all objective
measures of quality of care, we do quite well: maybe
not the best in the world but we're in the middle of
the rich countries of the world and that ain't a shabby
place to be. The place where we're not in the middle of
the pack is in how much we pay for that care.

Well that is perhaps obvious in a standard way of thinking, so it isn't
what I'm driving at.

When you said "our" and "we" on a geo-poli boundary basis, it implies
it is a legitimate collective of "we" accorded to those boundaries, I
wanted to know the moral/ethical value judgments one makes when they
decide it is a morally legitimate collective. I want to know why those
are the "right" boundaries. Of course, you might not be doing any such
judgement and are simply attempting to be objective as possible given
all the constraints. I understand, but I want a bit more than that.

Why should person X living in city A, be responsible for well being of
person Y, living in city B, when person X and Y don't know each other?
On what basis (of rights and privileges) can person Y make a legitimate
claim on person X for their health care, or any other "benefit" for
that matter? What is the rationale and morally correct way to set
political boundaries to get the "right" results? Who decides and why?
Why "we/our" for anything other than unanimous consent?

The comparisons are all for interfered (by gov) markets. Due to that,
no one really knows what health care "should" cost (by any chosen
boundary scan), or how much of it "should" be purchased, aggregate or
individual. No one knows what the mix of healthcare v. other goods
would be, aggregate or individual, if people could simply select based
on individual tastes and resources. I might sound like I'm dis'ing
attempts at objective comparative studies overall, but I'm not.

I reject the /political/ dictum of "the greatest good for the greatest
number." I wonder how others justify it.

Greg wrote:

Well that is perhaps obvious in a standard way of thinking, so it isn't
what I'm driving at.

You know, I don't think I've ever accused you of thinking in a standard
way. However, sometimes a cigar is just a cigar, and a discussion of
health system performance is just a discussion of health system
performance.

I reject the /political/ dictum of "the greatest good for the greatest
number." I wonder how others justify it.

If you re-read my comments in this thread, you'll see that I never
advocated a particular health system, or any particular organizing
approach. A bigger problem, from my perspective, is that there are people
who believe that the current US system is above reproach. If they think
the system is the best that it can be there's no reason to ever consider
changing it.

As I've said previously, there may be reasons why one would want to
de-regulate the health care system -- just that those reasons don't have
much to do with cost or quality of care. I would think that you would be
concerned about the cost-quality mismatch in the US compared to other
countries. In the case of the US, poor value is exacerbated by rare (over
the course of the lifespan) but catastrophically expensive events. The
rarer and more catastrophic an event, the harder it is for conventional
insurance companies to manage the risk and the more likely it is for there
to be calls for increasing the risk pool -- such as in universal care or
single-payer sytems (which aren't the same thing). That's the kind of
thing that drives you nuts, so I would think you'd be concerned about
value mismatch.