I’m having a surprisingly decent debate about healthcare (Obamacare, etc) over at Ethics Alarms, in a thread called The Ethics Of Demanding Charity. Robert is participating too. Check it out, if you like.
Below the cut: One of my comments. But you have to go to Ethics Alarms for the full context.
1) You’re talking about “survival rates,” but that’s not an accurate measure, since every needless diagnosis of a healthy patient – and we have a lot of those in the US – increases the “survival” rate. What matters is mortality rates, not survival rates – and when you look at those, the US advantage disappears. From a Reuters article by Sharon Begley:
Because cancer screening is much more widespread in the United States than in Europe, especially for breast and prostate cancer, “we find many more cancers than are found in Europe,” [biostatistician Dr. Don Berry of MD Anderson Cancer Center] said. “These are cancers that tend to be slowly growing and many would never kill anyone.”
Screening therefore turns thousands of healthy people into cancer patients, even though their tumor would never threaten their health or life. Counting these cases, of which there are more in the United States than Europe, artificially inflates survival time, experts said.
“As long as your calculation is based on survival gains, it is fundamentally misleading,” said Dr. H. Gilbert Welch, a healthcare expert at the Dartmouth Institute for Health Policy & Clinical Practice.
If you look at the mortality figures, the differences are small. The US does slightly better on breast cancer and prostate cancer, but worse on many other types of cancers, including lung cancer (which kills more people than breast and prostate cancer combined).
The most meaningful comparison is one called “rate of death that would be amenable to healthcare intervention,” which means deaths among people that good medical care could save (mortality among people under 75 years old who die from heart attacks, strokes, etc). The U.S. figure for this is 96 deaths per 100,000 people; in France, it’s 55 per 100,000.
2. I agree, the UK health care system is deeply flawed. Canada isn’t that great either. We tend to hear a lot about those countries’ medical systems because they speak English and lazy American journalists find it easier to report on those systems, but by worldwide standards they’re mediocre. (But so is the US’s medical system.)
3. You’re wrong on infant mortality. What you’re claiming (and it’s a common claim) is that other countries lower their infant mortality rates by classifying as “stillborn” – that is, born dead – infants that we in the US would count as “infant mortality.”
It’s easy to empirically test your claim, by combining infant mortality and stillbirth rates into a single figure, so that no death is uncounted due to classification. But when you do that, as I did in this post, the US still has a far higher death rate than any other wealthy country. No matter how you measure it, babies are more likely to die in the US than in other wealthy countries.
Also, there’s an enormous racial component – essentially, our infant mortality rate is much, much, higher among black babies than white babies, which is hard to account for under your theory, unless we suppose that doctors in hospitals try much harder to save black babies than white babies.
4. Yes, their taxes are higher – but that is accounted for in the comparison figures. The fact that other wealthy countries spend less per capita on health care than the US is too well-established to be worth arguing about; this isn’t a matter of opinion, it’s a matter of I know what I’m talking about, and you don’t.
To quote the health research site Epianalysis:
In the year 2006, each American’s healthcare cost $6,714, as compared to the $2,880 median among industrialized nations participating in the Organization for Economic Cooperation and Development (OECD), after adjusting for cost of living. As a percent of a country’s GDP, the U.S. also spent almost 16% of its GDP on healthcare as compared to between about 7% and 11% among other industrialized nations.
Yes, I got a bit techy towards Ablative Meatshield at the end there, but that’s still probably the most polite exchange we’ve had.
I heard a good quote recently:
“If the government can shut down roadways and parks and disability checks, why would you want to give them that power over your healthcare?”
Noting that many of the roadways and parks that the Federal government is asserting such authority over are State roads and parks that are (or were) partially funded by the Feds and that the States are perfectly willing and able to keep open with their own funding.
That’s a pretty ignorant quote. The Affordable Care Act, like Medicare, is pretty much immune to government shut-downs.
I’d be interested in any OBJECTIVE, SOURCED links showing that the typical government park shutdown is needless, legally voluntary (i.e., they have the legal authority to let other people run it if other people offer), and/or costs more than it saves. Btu in general, the parks thing just seems like Republicans being unable to take responsibility for their own actions. “We defunded the government because we didn’t get EVERYTHING WE WANTED EVER IN EXCHANGE FOR NO CONCESSIONS, but when things shut down that’s Obama being mean!” seems to be the message.
A typical example of the “evidence” I’ve seen in a right-wing editor (not reporter) in a right-wing newspaper claiming that an anonymous park employee had allegedly said they were ordered by someone not named to make things needlessly painful.
When you deliberately shut down the government, things shut down. Stop whining and take some responsibility.
EDITED TO ADD: “Stop whining” is my reaction to the GOP horror that some public parks shut down when the government is shut down. It’s not meant to be my reaction to Ron’s post, which was not whiney in any way. Sorry, Ron.
That debate won’t be civil for long. I’m going over there in a minute to call you a communist and everyone else dupes of the communist state.
We’re not horrified that the parks are closed. We’re just noting that the administration has chosen, on balance, to enhance and extend the pain of the shutdown by doing some fairly dumb things – spending money to close down things which don’t cost the government money to stay open, for example. (Don’t look at Mt. Rushmore, kids! The photons bouncing off of it cost the government billions every day.) http://siouxfallsbusinessjournal.argusleader.com/article/20131004/UPDATES/310040047/Rushmore-blockage-stirs-anger-S-D-
One of the Federal-level Amber Alert websites was closed down over the weekend. (It reopened in response to the loudest public squawking in the history of loud public squawking.) Somehow, the Michelle Obama ‘grow a garden, fatties’ shame site managed to find the operating budget to keep open over the same period.
http://www.wbtw.com/story/23627835/amber-alert-website-back-up-after-being-shut-down-all-weekend
And of course, it would be crazy to think that the government would play favorites, and deny WWII vets access to monuments while ensuring that the Mall would be open for a favored political cause’s rally.
http://www.washingtontimes.com/news/2013/oct/7/park-service-oks-immigration-reform-rally-closed-n/
As for the shutdown – since Republicans have offered to fund everything except the ACA, and Democrats have refused the offer, doesn’t it seem a little odd to continue blaming the Republicans. OK, they’re making their demand to not fund the ACA without making any concessions etc.
Why should they make concessions? They control the House. The House controls the money.
During the 20th century, pretty much every transformational federal program or initiative had significant, if not always overwhelming support. There’s a reason for that. We have an adversarial system, by design. One party is not *supposed* to be able to manufacture transformational change all by its lonesome.
If you put your eggs in the basket of “we will control both houses of the legislature for long enough to impose a radically new order on this sector of the economy” then you’d better either control them for quite a while or move fast with your revolution. You guys did neither and now it’s biting you in the ass. Tough. Obama’s incompetence doesn’t make this a “Republican shutdown” and the history books are not going to be kind.
No dice, Robert. The ACA struggle went like this:
1. The Republicans lost the elections, losing seats even in the House.
2. The Republicans lost the floor vote, making the ACA law.
3. The Republicans lost the Supreme Court challenge, upholding the ACA.
And now, since due process hasn’t gone the way they wanted it to, they try to force a government shutdown rather than permit a duly-passed and supported law go into effect? Nope. This shutdown is 100% the responsibility of the GOP, and the public knows it. Why on earth should Obama and the Democrats sacrifice a clearly-won victory just to make the losers happy and persuade them to do their jobs?
I think you may be a little fuzzy on what ‘winning’ and ‘losing’ mean. The Republicans lost, and they need to accept it instead of throwing tantrums.
1-3 are irrelevant to the current process. I don’t know if you are an American; if you are, then you needed to pay closer attention on civics class.
We don’t settle our legal issues with media opinions about what the election was a referendum on; our elections are referenda on who is going to fill these particular seats. Congress does not operate on a principle of stare decisis; one Congress is quite free to tear up the work of a previous one. The Supreme Court decision means that the ACA is not, in their view, repugnant to the Constitution; this fact creates no obligation in the Congress to keep the law in force.
Why should Obama and the Democrats give up their victory? To save the country from a shutdown, which your lot feels would be disastrous if it continues. The Republicans ARE doing their jobs – they are reflecting the desire of their constituents. “Help Obama make the ACA work” is not part of my representative’s job description; “kill the ACA stone cold dead” is.
It is you who are fuzzy on winning and losing, or at least on how those conditions apply in the legislature. There are no permanent laws; those which command bipartisan support may live a very long time indeed, but everything the Congress has ever done is at least theoretically reversible and temporary. “We won, we won” = great. But the Republicans control the chamber of the Congress that deals with the money, and the Republicans don’t have to finance your bill going forward.
Except their shutdown doesn’t stop the ACA anyway, because it’s self-funding. This is just children throwing a tantrum because they couldn’t get their way by going through proper channels. If their actions are so legitimate, why is that the U.S. government has never been forced into default over such an issue before?
I do not think this is true.
You might find this post relevant to the debate. You might also look at this study.
FWIW, we have outstanding preemie care. We consider infants survivable, and provide services to them, at a much younger age than other parts of the world.
Moreover, if you control for race and immigration status, the US gets even better. We don’t do as good a job providing health services to POC and immigrants, which is a failure of our system. But neither do other folks: the cited article, for example, notes that “Compared with the perinatal mortality rate of 10.1 per 1000 total births in UK born mothers, rates in infants of mothers born in India, Bangladesh, and Pakistan were 12.5, 14.3 and 18.8 respectively.” That’s a pretty universal trend and the population stats need to be adjusted for it.
In summary, you said:
That is simply untrue.
You might also look at this paper from the WHO. For a simple summary, look at figure 7.45. For detailed information, Table a1 starts on page 29.
As a measure of obstetric care, perinatal is the right statistic. And we’re doing well even if we don’t account for variance by race/immigration. We’re doing extraordinarily well if you account for the reality that we have one of the highest (if not THE highest) risk profiles among all our competition.
“This is just children throwing a tantrum because they couldn’t get their way by going through proper channels.”
This IS proper channels. They lost previous votes, yes. Now they are engaged in a legal, if dickish, maneuver using procedural rules to block the bill. That’s how it WORKS.
“If their actions are so legitimate, why is that the U.S. government has never been forced into default over such an issue before?”
A) Because no administration and Congress have been so fundamentally stupid as to ram through transformational legislation on a purely party-line vote, and
B) Because there is no BUDGET. When there is no budget, the ability to fiddle with continuing resolutions greatly magnifies the power of the Speaker of the House (and the Senate Majority Leader as well) to fuck with legislation. There hasn’t been a budget since 2009.
There’s blame to be fairly assigned on all sides, and I wouldn’t and don’t blame Democrats and/or liberals for being pissed off. But be pissed off because of the dickishness and at being outmaneuvered, not out of some newly-discovered reverence for the comity of Congress.
“If the government can shut down roadways and parks and disability checks, why would you want to give them that power over your healthcare?”
This quote would be akin to the Menendez brothers asking for mercy because they are orphans.
But indeed, we should keep the government out of Medicare.
Its worth pointing out something about ethics here.
Republicans are willing to shut the government down simply to prevent poor people from getting health insurance.
Now, we can debate the ethics of this.
NO. We can debate anything you like — but not until we raise the debt ceiling and pass a budget. I’ve been very clear on this.
Pass a budget that keeps us under the debt ceiling.
@Gin-and-whiskey:
Hooray! First time I’ve seen someone other than myself suggest the use of perinatal instead of infant mortality as a superior measure. It seems like a better measure for measuring health care. It’s tied more closely to medical care, which mostly occurs around delivery time, while infant mortality can include things like parental neglect 6 months down the road. It eliminates the discretion on how you count live births.
Any chance you stole the idea from me?