Author Topic: Universal Health Care  (Read 38518 times)

Manedwolf

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Re: Universal Health Care
« Reply #125 on: November 19, 2008, 09:06:59 PM »
Indeed, a good chunk of the research in America is state funded in the first place.

if you consider the gov funded schools it goes on at most of it is subsidized

Really?

Tell me where this magic subsidizing agency is, because my company would be very interested in getting this money from the sky. We fund our own research on medical devices.

The "medical R&D is all government funding" argument is a lie.

Headless Thompson Gunner

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Re: Universal Health Care
« Reply #126 on: November 19, 2008, 09:09:22 PM »
Me too, cassandra and sara's daddy.

The odd thing is, you're taking a system which pays out tons of government money (80 percent for the poor, with a fund to pay for people who can't afford the 20), taxes income to pay for healthcare (that's what "mandated savings" is-a tax on income), and then pays out government regulated rates on major medical (just like medicare)....and yet a heart surgery is about $90,000 cheaper.

???
But the Singapore government doesn't pay out tons of money, not relative to the other countries we've been discussing.  And they get better results (so say the studies) by not doing so.  

By your reasoning, wouldn't that means that paying less from the government is better, and that the Western universal health care schemes are inferior?  Lower costs, higher efficiencies, and all that?  

If you're going to be consistent,then you have to agree that UHC and/or massive government payouts are an inferior solution.

De Selby

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Re: Universal Health Care
« Reply #127 on: November 19, 2008, 09:10:03 PM »
Really?

Tell me where this magic subsidizing agency is, because my company would be very interested in getting this money from the sky. We fund our own research on medical devices.

The "medical R&D is all government funding" argument is a lie.

Yeah, I do believe he said "a good chunk"-just because your company doesn't get it doesn't mean it exists.

I mean, I don't get welfare-does that mean that "poor people getting tax money" is a lie?
"Human existence being an hallucination containing in itself the secondary hallucinations of day and night (the latter an insanitary condition of the atmosphere due to accretions of black air) it ill becomes any man of sense to be concerned at the illusory approach of the supreme hallucination known as death."

cassandra and sara's daddy

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Re: Universal Health Care
« Reply #128 on: November 19, 2008, 09:11:01 PM »
check the japanese system next  and ask yourself why nih sends folks there when they could offer no more treatment here
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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De Selby

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Re: Universal Health Care
« Reply #129 on: November 19, 2008, 09:14:21 PM »
If you're going to be consistent,then you have to agree that UHC and/or massive government payouts are an inferior solution.

It is a universal healthcare scheme-if you're poor, the government pays.  If you have money, the government taxes and then uses that money to pay fixed (by government) rates for major medical care.  

The private system competes with that.

The reason why it spends less money is that the provision of services costs much, much less.  

So that's the question:  If government regulation and taxing to pay for the poor drives up the cost, how come Singapore's cost is far below what it is in the US?

It obviously has more regulation than here (basically it has medicare for everyone, and it covers 100 percent of the population with government funds...the poor get out of the government's account, the wealthy get taxed and forced to pay for their own)....yet it's much cheaper.

See the problem with your reasoning there?  By your logic, the "individual cost" angle should make American healthcare the cheapest and most efficient in the world, but it's not.  So what's doing it in Singapore?
"Human existence being an hallucination containing in itself the secondary hallucinations of day and night (the latter an insanitary condition of the atmosphere due to accretions of black air) it ill becomes any man of sense to be concerned at the illusory approach of the supreme hallucination known as death."

cassandra and sara's daddy

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Re: Universal Health Care
« Reply #130 on: November 19, 2008, 09:17:37 PM »
http://en.wikipedia.org/wiki/Research_funding
The US government spends more than other countries on military R&D, although the proportion has fallen from around 30% in the 1980s to under 20%[1]. Government funding for medical research amounts to approximately 36% in the U.S


more from the dems
    
Government-Funded Research Enhances Our Quality of Life and Promotes Economic Growth


The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the U.S. It provides grants and contracts to support research in over 2,000 research institutions in the U.S. and abroad, and conducts more than 2,000 research projects in its own laboratories. NIH grants have also trained a host of scientists in its intramural programs and supported the training of hundreds of thousands of scientists at universities and medical schools around the country through research grants. The list of those scientists who have received NIH support over the years includes 106 Nobel Laureates, five of whom made their prize-winning discoveries in NIH laboratories. NIH reports a number of scientific advances supported by its research dollars, including:

    * Improved understanding of heart disease. In 1948, NIH inaugurated the Framingham Heart Study, a project to identify the common factors or characteristics that contribute to cardiovascular disease (CVD). At the time, little was known about the general causes of heart disease and stroke, but the death rates for CVD had been increasing steadily since the beginning of the century and had become an American epidemic. Over the years, careful monitoring of the Framingham Study population has led to the identification of the major CVD risk factors - high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity. Since its inception, the study has produced approximately 1,200 articles, making the concept of CVD risk factors integral to the medical curriculum. This has led to the development of effective treatment and preventive strategies in clinical practice.

    * Chemotherapy as a standard treatment for cancer. Work done during the 1950's and 1960's by NIH researchers led to the development of the first successful cures for a leukemia. This played a major role in establishing chemotherapy as a standard cancer treatment.

    * Cigarette - lung cancer link. In the late 1990's, researchers supported by NIH found the first direct biological link between cigarette smoking and lung cancer. Scientists had long associated cigarette smoking with lung cancer, but this discovery uncovered the molecular basis for how smoking leads to lung cancer.

    * Breast cancer treatment validation. In the mid-1990's, researchers supported by NIH showed that women at high risk of developing breast cancer who took tamoxifen had 49 percent fewer cases of breast cancer than those who did not. Tamoxifen has been hailed as the first drug to prevent breast cancer in women at high-risk for the disease.

    * Anti-cancer drug. In 2001, NIH funded the lion's share of the basic research that eventually led to the discovery and development by the drug company Novartis of a new drug known as Gleevec. It is the first anti-cancer drug specifically developed to target a molecular problem that causes a particular type of cancer, in this case, chronic myelogenous leukemia (CML).

    * Searching for a diabetes treatment. In 2002, scientists at NIH and the University of Texas Southwestern Medical Center successfully used the hormone leptin to treat patients suffering from lipodystrophy, a rare and difficult to treat disorder that shares some of the characteristics of typical type 2 diabetes. Diabetes is the sixth leading cause of death in the U.S. and is responsible for $92 billion in direct medical costs per year.

    * Epilepsy treatment. In the early 1990's, NIH scientists helped to develop a major new drug for epilepsy, felbamate, that is safe at high doses and does not have side effects commonly associated with other antiepileptic drugs.

    * Decrease in Sudden Infant Death Syndrome. Between 1992 and 1996, the rate of Sudden Infant Death Syndrome (SIDS) dropped by 38 percent. Much of that drop was likely due to a 66 percent decrease during the same period in the number of U.S. infants being placed to sleep on their stomachs. The Back to Sleep Campaign, a national campaign that encourages infants to be placed to sleep on their backs, was launched by the National Institute of Child Health and Human Development (NICHD) in partnership with several other organizations in 1994.

    * Advances in rubella detection and prevention. In the 1960's, NIH researchers developed the first licensed rubella vaccine and the first test for rubella antibodies that was practical for large scale testing (rubella hemagglutination inhibition test). Deaths from rubella have decreased 99 percent since the vaccine became available.

    * Juvenile typhoid vaccine. In 2001, NIH researchers and others supported by NIH developed and tested the first vaccine capable of protecting children ages 2 to 5 against typhoid fever. Seemingly the most effective typhoid vaccine ever developed, it is also virtually free of side effects. About 16 million people worldwide develop typhoid each year, and 600,000 die from the disease.

    * Mother-infant HIV transmission treatment. In the late 1990's, researchers supported by NIH demonstrated an affordable and practical strategy for preventing transmission of the HIV virus from mother to infant. A single oral dose of the antiretroviral drug nevirapine given to an HIV-infected woman in labor and another to her baby within three days of birth reduced the transmission of virus by half compared with a similar short course of AZT.

    * Smallpox vaccine dilution trial. In 2002, an NIH-supported clinical trial demonstrated that the existing U.S. supply of smallpox vaccine - 15.4 million doses - could successfully be diluted up to five times and retain its potency, greatly expanding the number of people it could protect from the contagious disease.

    * Staph bacteria vaccine. In 2002, NIH scientists and the company Nabi developed the first successful vaccine against Staphylococcus aureus, a major cause of infection and death among hospital patients. Recently, researchers have discovered strains of the bacteria that are resistant to the antibiotics used to treat them, making a preventive vaccine critical.

    * Urinary incontinence treatment. In 2002, researchers supported by NIH showed that rural older women with urinary incontinence (UI) could use behavioral changes, such as bladder training, and pelvic muscle exercises with biofeedback, to reduce their UI severity by 61 percent. UI is a leading reason for people in rural areas to move to a nursing home, and controlling it leads to a better quality of life and allows people to remain in their homes longer.

The National Institutes of Health is not the only source of federally-funded advances in medical technology. A number of other federal agencies, including the National Aeronautics and Space Administration (NASA) and the National Institute of Standards and Technology (NIST), have supported research that has improved public health in the United States and around the world.

    * Advances in medical laser technology. Laser technology that originated in NASA's satellite-based atmospheric studies in the mid-1980s has been applied to a variety of medical fields. NASA-developed switching technology, for instance, was used to produce a uniform controllable laser beam maintained at a low working temperature. Lasers of this type are being used to correct myopia (nearsightedness) and to perform laser angioplasty, which vaporizes blockages in coronary arteries.

      Laser angioplasty is helping to prevent cardiac arrest with a success rate of 85 percent at opening blocked arteries. At the same time, this procedure positively impacts patients' recovery time, costs and productivity. The same type of technology allows medical facilities, in a one-minute procedure, to correct myopia. According to NASA there are an estimated 60 million nearsighted Americans who will not need glasses if they undergo this procedure.

    * Breast biopsy system. Technology developed at NASA's Goddard Space Center for the Hubble Space Telescope in 1997 has found a new application in breast biopsies. A high technology silicon chip converts light directly into electronic or digital images that can be manipulated and enhanced by computers. Known as stereotactic core needle biopsy, the procedure is performed under local anesthesia with a needle instead of a scalpel, leaving a small puncture wound rather than a large scar.

      Recent statistics from the American Cancer Society show that approximately one in nine women in the United States will develop breast cancer at some point in their lives. This new technique, which is replacing surgical biopsy as the method of choice in many cases, is saving women pain, scarring, time, and money. Compared to traditional surgery, the new procedure is just as effective and can be performed in a physician's office for about one-quarter the cost. NASA estimated in 1997 that this procedure would reduce national health care costs by about $1 billion a year.

    * Advanced pacemaker. In 1969, NASA and the Applied Physics Laboratory of Johns Hopkins University began working with private industry to apply NASA-developed aerospace technology into pacemakers. Through this collaboration, technology originally designed for two-way communication with satellites has been used since 1997 as a means of communicating with and reprogramming pacemakers without the need for further surgery. Additionally, space microminiaturization technology and spacecraft electrical power system technology have been applied to produce the first single-chip pacemakers with rechargeable, long-life batteries.

      Pacemakers help people with heart rhythm disorders live longer, more productive lives. According to NASA, by the late 1990's, the U.S. pacemaker market totaled over $1 billion annually and was on a trajectory to continue growing at a rate of 8 percent annually.

    * New DNA biochip technology. While working on a project to develop advanced biosensors in 1994, scientists at the Department of Energy's Oak Ridge National Laboratory developed a DNA diagnostic biochip. The hand-sized device, which uses less blood than current procedures, may eventually be used to diagnose diseases such as AIDS, cancer and tuberculosis in the doctor's office without the need for a separate testing facility.

      According to NASA, many drugs work on less than 50 percent of all patients and there are approximately 100,000 deaths each year in the US resulting from the adverse effects of medication. Biochip technology will support more specific diagnostics, prediction of response to drugs, and safer, individualized medication.

    * Infrared Thermometer. NASA's Technology Affiliates Program seeks to improve the competitiveness of American industries by facilitating the transfer of government-developed technology to the private sector. Through this program, technology initially used to view and measure the emitted infrared radiation from planets and stars was refined in the late-1980's and early-1990's to develop the infrared thermometer. This almost instantaneous method of taking body temperatures, introduced to the commercial market in 1990, is easier and much faster (1 second as compared to 30 seconds) than previous oral or rectal methods.

      According to NASA, the economic potential for the thermometer worldwide for acute care hospitals is approximately $126 million a year. A roughly similar value is predicted for sales to alternate care facilities, such as clinics, physician's offices, and nursing homes as well as to individuals. Furthermore, infrared thermometers save considerable valuable time for hospital personnel and are less intrusive to the patient.

    * Advances in dental technology. In the late 1920's, laboratories at the National Institute of Standards and Technology (NIST) began what continues to be a collaboration with the American Dental Association to develop, refine, and generally improve medical practice through the invention of new dental materials, tools and methods. One of the more significant advances to come out of this collaboration was the introduction in the late 1950s of new polymeric and mineral-based materials for aesthetic tooth restoration and the development of metallic alloys for amalgams.

      Over the past four decades, American dentists have made hundreds of millions of restorations with these dental polymers. It was estimated in 1987 that the increased durability of composite restorations, and thereby the reduction of replacement costs of previously used materials, saved Americans more than the combined appropriated budgets of NIST, the ADA, and the National Institute of Dental Research. The U.S. market for these products is now $163 million per year (American Dental Association, National Institute of Standards and Technology, and Strategic Dental Marketing Corp.).
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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Headless Thompson Gunner

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Re: Universal Health Care
« Reply #131 on: November 19, 2008, 09:18:08 PM »
was there hidden in there an explanation of why its so much cheaper there? i missed it
Let me summarize:  

In Singapore, everyone pays at least a portion of the costs they incur, even the poor.  Most people pay all of the costs they incur.  This creates strong incentives to patients to minimize the amount of service they consume.  This goes a long way to keeping costs down.

Care providers must publish their prices.  This enables price shopping, which doctors and hospitals even more incentive to keep their prices down.

Routine care is paid by individuals out of pocket, from mandated personal savings accounts.  Yet again, incentives to keep costs down.  When it's your money, you tend to use less.  They use insurance only for major medical costs, not for routine care.  This means people are covered int he event of a catastrophic illness, and it also means that insurance costs stay reasonable.

cassandra and sara's daddy

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Re: Universal Health Care
« Reply #132 on: November 19, 2008, 09:20:27 PM »
http://www.npr.org/templates/story/story.php?storyId=89626309

2008 ·  Japan produces cars, color TVs and computers, but it also produces the world's healthiest people. It has the longest healthy life expectancy on Earth and spends half as much on health care as the United States.

That long life expectancy is partly due to diet and lifestyle, but the country's universal health care system plays a key role, too.

Everyone in Japan is required to get a health insurance policy, either at work or through a community-based insurer. The government picks up the tab for those who are too poor.

It's a model of social insurance that is used in many wealthy countries. But it's definitely not "socialized medicine." Eighty percent of Japan's hospitals are privately owned — more than in the United States — and almost every doctor's office is a private business.

Health Care for Anyone at Anytime

Dr. Kono Hitoshi is a typical doctor. He runs a private, 19-bed hospital in the Tokyo neighborhood of Soshigaya.

"The best thing about the Japanese medical system is that all citizens are covered," Kono says. "Anyone, anywhere, anytime — and it's cheap."

Patients don't have to make appointments at his hospital, either.

The Japanese go to the doctor about three times as often as Americans. Because there are no gatekeepers, they can see any specialist they want.

Keeping Costs Low

Japanese patients also stay in the hospital much longer than Americans, on average. They love technology such as magnetic resonance imaging; they have nearly twice as many scans per capita as Americans do. A neck scan can cost $1,200 in the United States.

Professor Ikegami Naoki, Japan's top health economist, explains how Japan keeps MRIs affordable.

"Well, in 2002, the government says that the MRIs, we are paying too much. So in order to be within the total budget, we will cut them by 35 percent," Ikegami says.

This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.

That helps keep premiums to around $280 a month for the average Japanese family, a lot less than Americans pay. And Japan's employers pick up at least half of that. If you lose your job, you keep your health insurance.

An Accommodating Insurance System

Japanese insurers are a lot more accommodating than their American counterparts. For one thing, they can't deny a claim. And they have to cover everybody.

Even an applicant with heart disease can't be turned down, says Ikegami, the professor. "That is forbidden."

Nor do health care plans covering basic health care for workers and their families make a profit.

"Anything left over is carried over to the next year," Ikegami says. If the carryover was big, "then the premium rate would go down."

Perhaps Too Cheap?

So here's a country with the longest life expectancy, excellent health results, no waiting lists and rock-bottom costs. Is anyone complaining?

Well, the doctors are. Kono says he's getting paid peanuts for all his hard work.

If somebody comes in with a cut less than 6 square inches, Kono gets 450 yen, or about $4.30, to sew it up.

"It's extremely cheap," he says.

Kono is forced to look for other ways to make a yen. He has four vending machines in the waiting room. In a part of Tokyo with free street parking, he charges $4 an hour to park at his clinic.

The upside is that virtually no one in Japan goes broke because of medical expenses.

Personal bankruptcy due to medical expenses is unheard of in Japan, says Professor Saito Hidero, president of the Nagoya Central Hospital.

Hospitals Hit Hard

But while the patients may be healthy, the hospitals are in even worse financial shape than the doctors.

"I think our system is pretty good, pretty good, but no system is perfect," he says. "But 50 percent of hospitals are in financial deficit now."

So here's the weakness: While the United States probably spends too much on health care, Japan may be spending too little. In a country with $10-a-night hospital stays, prices just aren't high enough to balance the books.

Hospital prices too low? That's a problem a lot of countries would like.
 
Related NPR Stories

    *
     
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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cassandra and sara's daddy

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Re: Universal Health Care
« Reply #133 on: November 19, 2008, 09:21:25 PM »
and the japanese system covers ganjin too
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


by someone older and wiser than I

De Selby

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Re: Universal Health Care
« Reply #134 on: November 19, 2008, 09:22:53 PM »
So a heart surgery costs $90,000 less than in the US because it's covered by insurance in Singapore for residents, and regular visits are not covered by insurance, and because the government taxes your income and forces you to spend it on care (I note that you were recently championing the benefits of not having mandated savings-like how you relied on your parents to not spend money on medical care)....?

Not seeing how that's an explanation of the lower cost for each individual service, as opposed to the lower total spent.

Cost for service and amount spent are two different things.  You are talking amount spent; how do you explain the staggering difference in costs?
"Human existence being an hallucination containing in itself the secondary hallucinations of day and night (the latter an insanitary condition of the atmosphere due to accretions of black air) it ill becomes any man of sense to be concerned at the illusory approach of the supreme hallucination known as death."

cassandra and sara's daddy

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Re: Universal Health Care
« Reply #135 on: November 19, 2008, 09:24:07 PM »
chirp  chirp
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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De Selby

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Re: Universal Health Care
« Reply #136 on: November 19, 2008, 09:27:41 PM »
chirp  chirp

See, like you gave an article with an obvious answer for Japan
Quote
This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.

Not seeing the same from other folks here for why the US is twenty times more expensive than anywhere else, including the supposed "free market" Singapore where everyone is covered and the government forces you to pay a tax to cover your health.
"Human existence being an hallucination containing in itself the secondary hallucinations of day and night (the latter an insanitary condition of the atmosphere due to accretions of black air) it ill becomes any man of sense to be concerned at the illusory approach of the supreme hallucination known as death."

ronnyreagan

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Re: Universal Health Care
« Reply #137 on: November 19, 2008, 09:28:53 PM »
The US is indeed less healthy than most UHC countries.  But that isn't because we lack UHC.  It's because we're less healthy.

So you are saying that we are less healthy than most UHC countries because... what? Not our health care system? Because we have the worst genes in human history? If you're going to say obesity, I hope you've got more than that.
You have to respect the president, whether you agree with him or not.
Obama, however, is not the president since a Kenyan cannot legally be the U.S. President ;/

cassandra and sara's daddy

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Re: Universal Health Care
« Reply #138 on: November 19, 2008, 09:30:07 PM »
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


by someone older and wiser than I

Headless Thompson Gunner

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Re: Universal Health Care
« Reply #139 on: November 19, 2008, 09:31:09 PM »
It is a universal healthcare scheme-if you're poor, the government pays.  If you have money, the government taxes and then uses that money to pay fixed (by government) rates for major medical care.  
  Not true.  If you're poor, they only pay a portion of your costs, you're still on the hook for some of what you need.  If you're wealthy, you're forced to set aside some of your income for medical expenses.  You may choose to use some of that savings to buy government major medical insurance.  Or you may choose not to.

The reason why it spends less money is that the provision of services costs much, much less.  
  Yup.  Properly aligning the incentives will tend to do that.  I assume less bureacracy is involved in Singapore, too.  I doubt they have the US FDA to deal with, and devote less to new development

So that's the question:  If government regulation and taxing to pay for the poor drives up the cost, how come Singapore's cost is far below what it is in the US?
  If all you do is pay for the very poor, and then only for a proportion of the costs, then costs may not rise appreciably.

It obviously has more regulation than here (basically it has medicare for everyone, and it covers 100 percent of the population with government funds...the poor get out of the government's account, the wealthy get taxed and forced to pay for their own)....yet it's much cheaper.
  I don't believe that's true.  They fund their system differently, but I've seen no indication that it's regulated more there.  If anything, given the massive FDA regulation we have here, it's almost a given that they regulate less there.

Also, My reading indicates that most of Singapore's health care is self-funded by the individuals who need care.  Most people pay with private savings and personal insurance, not government funds.

See the problem with your reasoning there?  By your logic, the "individual cost" angle should make American healthcare the cheapest and most efficient in the world, but it's not.  So what's doing it in Singapore?
Individual cost is what they have in Singapore, not here.  Here in the US most routine care is paid by insurance, which is a layer removed from individual cost.

Headless Thompson Gunner

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Re: Universal Health Care
« Reply #140 on: November 19, 2008, 09:34:08 PM »
So you are saying that we are less healthy than most UHC countries because... what? Not our health care system? Because we have the worst genes in human history? If you're going to say obesity, I hope you've got more than that.
Americans live distinctly less healthy lifestyles compared to most other developed countries.

cassandra and sara's daddy

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Re: Universal Health Care
« Reply #141 on: November 19, 2008, 09:34:54 PM »
The copayment
rate differential to which insured workers and their dependents are
subjected has been largely cushioned by the fact that any out-of-pocket
copayment faced by a patient in a given month over the amount of 57,000
yen ($438) [or 30,000 yen ($231) for those with low income] is reimbursed
regardless of the plan. These measures have inhibited the extensive
development of a competitive private insurance alternative. Most
private insurance offerings are for supplemental benefits, to cover amenities
during a hospital stay or other incidental expenses.
Thus, Japan has one of the most equitable single-tiered health care
systems in the world. According to a 1988 survey. conducted in Tokyo,
neither the utilization rate nor the health care expenditure per person
was affected by an individual’s income level.8 In a national survey in 1985,
of those who had experienced an illness but had not seen a physician,
only 0.4 percent gave economic reasons for not having done so.9 Out-ofpocket
expenses for copayments amount to only 12 percent of the total
health care expenditure provided under social insurance.
The key factor that allows for this level of equity under a multiple-payer
system is the government’s central role in managing and subsidizing the
plans that insure the financially disadvantaged. As shown in Exhibit 1,
in the government-managed health insurance for those employed in small
enterprises, the central government acts as the insurer and provides a
direct subsidy from the general budget amounting to 16 percent of its total
expenditure. In the national health insurance plan for the self-employed
and pensioners, local governments act as insurers, and the central govJAPANESE
SYSTEM 93
emment provides a direct subsidy amounting to half of total expenditures.
For the elderly, the central pooling mechanism is financed through
contributions from the national and local governments-the former, 20
percent, and the latter, 10 percent of expenditures-and from funds
pooled from all plans. Because those individuals who are employed by
large companies or in the government have relatively high incomes and
tend to have better health status, no public subsidies are given to the
insurance societies and the mutual aid associations, with the exception
of some modest support for administrative expenses.
Are Japanese Health Care Costs Truly Low?
Among the major industrialized nations, Japan’s personal health expenditures
are virtually the lowest, according to data collected by the
Organization for Economic Cooperation and Development (OECD). But
are Japan’s costs really that low? The first question that confounds any
international expenditure comparison is the difference in statistical compilation.
The boundaries between health care, human services, environmental
protection, and education are not clearly drawn, so that what is
aggregated under “health care” need not be, and is not, the same. The
OECD has attempted to standardize the cross-national variations; it
estimates that Japan spent 6.8 percent of its gross domestic product
(GDP) on health care in 1987, 3 percent higher than the official Japanese
government figure of 6.4 percent.10 The latter estimate is probably an
understatement, since it is based only on the social insurance expenditures
and excludes expenses for normal child delivery, direct medical
education and research expenditures, grants to public hospitals, preventive
health measures, private room charges, and private gifts to physicians
(which I discuss later). Thus, the 3 percent difference may be regarded as
too small for comparative purposes.- However, the OECD figure is the
best comparable data currently available; even if increased by as much as
10 percent, this estimate would still be well below that of the major OECD
countries, with the exception of the United Kingdom and Italy.
The second question is whether health care costs are low when
compared with the service demands placed upon the system. The problems
assailing the U.S. health care system and certainly adding to its
higher costs-such as the high prevalence of people who abuse alcohol
and drugs, engage in criminal practices that lead to death and injury, or
have acquired immunodeficiency syndrome (AIDS)-are of a significantly
lower magnitude in Japan. In particular, only 195 persons were
reported as manifesting AIDS as of August 1990, most of whom were
hemophiliacs.11 With a little more than twice Japan’s population, the
94 HEALTH AFFAIRS | Fall 1991
United States has about 180,000 AIDS patients. The Japanese may also
have a healthier diet: only 25.5 percent of total calories come from fat
(1988). 12 Another factor is the litigious nature of American society, which
has led to malpractice suits and, of more significance economically,
defensive medicine. In contrast, the number of lawyers per capita in Japan
is about one-tenth that of the United States, and malpractice suits are far
less common.
On the other hand, some negative factors in the Japanese lifestyle may
counterbalance these positive attributes. About 61 percent (1989) of men
over age twenty smoke, down from 84 percent in 1966 but still well above
the U.S. rate and that of many other countries.13 The Japanese diet has a
high salt content (daily consumption rate of 12.2 grams), which has led
to a high incidence of cerebrovascular disease. Also, the manner in which
Japan provides geriatric care to its elderly citizens is not likely to be a
factor in explaining health spending differences. The ratio of individuals
over age sixty-five is similar to that of the United States-about 12
percent. Although some 62 percent of the elderly live with their children
in Japan, the institutionalization rate is quite high (6.2 percent) and is
comparable to that of the United States. Thus, popular beliefs about the
veneration of the elderly and the willingness of children to provide care
in their homes in Japan are not borne out by available data. Moreover,
the major burden for taking care of the elderly falls on the health care
system because of the inadequate provision of social services. Of those
institutionalized, 75 percent are in hospitals and clinics.14
The third dimension to be considered is the denominator in health
costs. Since Japan’s GDP has grown rapidly, the relative cost of health
care has remained low when compared with most other countries, which
have not experienced rapid economic expansion. According to George
J. Schieber, of the seven major OECD countries, Japan had the highest
growth in real per capita health expenditure during 1960-1987, adjusted
for health care inflation and population growth.15 The increase was 8.18
times or 8.1 percent annually (the equivalent U.S. figure was 2.78 times
and 3.9 percent, respectively). However, it should be noted Japan was
still a relatively poor country in 1960 with a per capita expenditure of
only $258 (purchasing power parity), compared with $1,489 in the
United States. Thus, a more meaningful comparison is the real elasticity-
the compound annual rate of growth in real per capita health
spending relative to the compound annual rate of growth in real per capita
GDP. This figure comes to 1.46 annually during 1960-1987 for Japan,
which is well below the U.S. figure of 1.80 for the same period.
After one examines the above caveats, health care costs are definitely
low in comparison with the United States and very likely in comparison
JAPANESE SYSTEM 95
with Canada, France, and Germany as well. While the spending differential
that exists between these countries could be partly attributed to
the social systems in question, the following measures are important in
Japan’s effort to moderate the growth of its health spending.
Mechanisms For Cost Containment
The nationally uniform fee schedule has already been cited as playing
a key role in maintaining equity. It has also been the primary mechanism
for containing total health care expenditure. This is because it establishes
both the scope and standard of services that can be provided. Neither
providers nor payers can negotiate individually to expand benefits; any
such decision must be made by government. Because any benefit expansion
must apply to all insurers, the government has a strong incentive to
constrain the growth of total health expenditures. The incentive derives
from the fact that the government subsidizes the plans at a fixed rate;
when plan expenditures increase, so does the government’s subsidy.
When the Japanese government began to focus on containing overall
public expenditures in the early 1980s, one of its targets in relation to
medical care was limiting the increase in the fee schedule.16 The general
effort to constrain public expenditures came in the context of an Administrative
Reform campaign spearheaded by private business interests and
the Ministry of Finance in reaction to the huge deficit spending in the
1970s. A committee headed by Dokou, honorary chairman of the Japan
Federation of Economic Organizations, recommended in a widely publicized
report that the combined burden of taxation and Social Security
payment should remain below the level of 45 percent (recently amended
to 50 percent) of GDP. This ceiling, the committee said, should apply
even when the number of elderly reaches its maximum in the year 2020.
This report, along with support from the Ministry of Finance, was
successful in creating a national consensus on constraining public-sector
spending. Health care costs, as a major contributor to the deficits, became
an obvious target. The degree of success can be seen in Exhibit 2. Health
spending as a proportion of GDP (Japanese government estimates) increased
from 4 percent to 6 percent in the 1970s. However, the pace
slackened greatly in the 1980s. A similar pattern can be observed in the
premiums that employers and employees contribute to the governmentmanaged
health insurance plan: the rate increased from 7 percent in 1970
to 8.5 percent in 1982 but has now decreased to 8.3 percent. This has
been reflected in the reduced proportion of an average worker’s income
devoted to health services. Currently, the average worker’s health care
expenditure (insurance premiums plus out-of-pocket expenses) amounts
96 HEALTH AFFAIRS | Fall 1991
Exhibit 2
Changes In The Ratio Of Health Care Expenditures In Japan, 1970-1988
Sources: Kousei Tokei Kyokai, “1990 Trends in the Nation’s Health,” Kousei No Shihyou 37, no. 9 (1990): 234;
and Kousei Tokei Kyokai. Hoken to Nenkin no Dokou (Tokyo: Kousei Tokei Kyokai, 1989), 63, 107.
to 3.7 percent of income, a reduction to a mid-1970s leve1.17
The actual negotiations for any revisions in the fee schedule take place
in the Central Social Medical Care Council of the Ministry of Health
and Welfare. This council comprises eight representatives from providers
(five physicians, two dentists, and one pharmacist), eight from payers
(four from insurers, which includes two from the government, and two
each from management and labor), and four to represent public interests
(three economists and one lawyer). Global increases are based on the
periodic survey made every second year of the financial state of hospitals
and clinics (the latter being equivalent to a study on physicians’ income).
As noted, beginning from the revision made in 1981, the government
has exerted strong pressure to contain increases in the fee schedule.
Revenues used to grant fee increases derived largely from reductions in
government-regulated prices for pharmaceuticals. Thus, while medical
fees were allowed to increase 27 percent from 198 1 to 1990, a 52 percent
decrease in drug prices and cuts in laboratory test fees left the net increase
for fees and prices at only 2.4 percent, far below the 15 percent increase
in inflation that occurred during this period.
As a result of these cost containment measures, Japanese health care
costs have been kept at a level considerably below that of the United
States. The average cost per day, inclusive of all services, averages only
13,523 yen ($101) for inpatient care (including physician expenses) and
4,329 yen ($33) for an outpatient visit (including medication). For new
technology, the fee is set by comparing it to the nearest existing procedure,
equipment, or drug. For example, the fee for a magnetic resonance
JAPANESE SYSTEM 97
imaging (MRI) examination is only 23,000 yen ($177), just 4,000 yen
($28) more than for a regular CT body scan. Importantly, the total
revenue derived from billing for itemized services must pay not only for
operating expenses, but also for capital acquisition costs. This practice is
particularly significant for the physician owners of clinics and hospitals
because they have very few revenue sources outside of the services
provided under social insurance. This explains why the physician owners
cannot make large investments in high-technology equipment.
Another constraining influence on medical costs is the retrospective
review of claims sent by providers to third-party payers. Detailed itemby-
item claims of the services rendered must be sent by every institution
at the beginning of each month to the intermediary payment funds that
operate at the prefecture level. These claims are then inspected by the
funds’ designated panel of physicians. If the panel concludes that excessive
numbers of procedures or drugs have been provided, payment can be
denied for those items. In addition, claims over the amount of five million
yen ($38,462) are subjected to special reviews at the national level.
It is difficult to evaluate the effectiveness of this claims review mechanism.
The average time for reviewing each bill is less than one second
because of the huge number of claims (1.6 billion a year) that must be
reviewed manually; electronic billing is still not permitted in Japan. Even
with administrative screening,-there are still too many bills for objective
evaluation, Moreover, the only information available is in the form of
itemized services provided in the past month, which are checked against
the patient’s age, sex, and diagnosis. This has led to the practice of adding
a diagnosis so that a particular procedure will pass review. As a consequence,
it is common to see four or five, or even ten, diagnoses on a
patient’s bill. On the other hand, the peer review panel does have
empirical knowledge of the practice patterns of the institutions in the
community and tends to be more rigorous in checking claims coming from
the more questionable providers. The arbitrariness of this process, plus
the time-consuming nature of the appeals process, may discourage physicians
from providing more services to their patients than are deemed
clinically necessary. Thus, even though the actual ratio of the claims
judged as providing excessive care is less than 1 percent, the sentinel
effect of peer review may be greater than this figure suggests.18



lots of government involvement here  oh no!!!
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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De Selby

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Re: Universal Health Care
« Reply #142 on: November 19, 2008, 09:39:27 PM »
Headless,

Hmm....it went from "The US system is the best! It lets people choose not to buy care, like the 40 million who don't really want it, and it lets people like me rely on mom and dad"

To: "See, the US doesn't have a market system, because it's all paid for by private insurance...and the private insurance that pays private hospitals through privately negotiated agreements just isn't a market scenario like the government mandated savings and medical programs in Singapore."

To: "The FDA is keeping us all unhealthy by doing too must testing and delaying."

The only part that's consistent is the ideological rhetoric-the claims about the facts have waffled dramatically here.  I'm not sure I know which solution you're advocating, or if you now believe there is a problem with the US system (you seemed to be denying it), or if you think that people come from all over the world to the US because it's more inefficient and less market based or because it's more efficient and more market based...

Confusing, for sure.
"Human existence being an hallucination containing in itself the secondary hallucinations of day and night (the latter an insanitary condition of the atmosphere due to accretions of black air) it ill becomes any man of sense to be concerned at the illusory approach of the supreme hallucination known as death."

cassandra and sara's daddy

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Re: Universal Health Care
« Reply #143 on: November 19, 2008, 09:45:34 PM »
see pages 105 to 108 in the pdf on the japanese system for a summary
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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Headless Thompson Gunner

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Re: Universal Health Care
« Reply #144 on: November 19, 2008, 09:56:14 PM »
Headless,

Hmm....it went from "The US system is the best! It lets people choose not to buy care, like the 40 million who don't really want it, and it lets people like me rely on mom and dad"

To: "See, the US doesn't have a market system, because it's all paid for by private insurance...and the private insurance that pays private hospitals through privately negotiated agreements just isn't a market scenario like the government mandated savings and medical programs in Singapore."

To: "The FDA is keeping us all unhealthy by doing too must testing and delaying."

The only part that's consistent is the ideological rhetoric-the claims about the facts have waffled dramatically here.  I'm not sure I know which solution you're advocating, or if you now believe there is a problem with the US system (you seemed to be denying it), or if you think that people come from all over the world to the US because it's more inefficient and less market based or because it's more efficient and more market based...

Confusing, for sure.
Oy.  Your reading comprehension fails you.  Lemme make this dirt simple for you, since you're so easily confused.  We'll take it one item at a time.

Ready?  Here we go.  Try to keep up.

First...

The US system is better than the UHC systems typically used in developed Western countries.  If we're only considering those options, the US system is definitely the best. 

The Singapore system is better than the US system in many ways, and better than Western UHC in almost every way. 

None of these are perfect.
« Last Edit: November 19, 2008, 10:02:11 PM by Headless Thompson Gunner »

Headless Thompson Gunner

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Re: Universal Health Care
« Reply #145 on: November 19, 2008, 10:01:43 PM »
Still with me? 

Second...

Costs respond to economic factors.  Incentives are probably the most important such factor for our purposes here

If there are strong incentives to keep prices down, prices will naturally tend to stay down. If there are no incentives to keep prices down, prices will naturally tend to rise, unless arbitrarily capped by an outside force.

Outside forces (government) can mandate low prices, but that comes with side effects such as shortages.

cassandra and sara's daddy

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Re: Universal Health Care
« Reply #146 on: November 19, 2008, 10:10:47 PM »
man  me and the japanese health system feel left out   and it deals with 122 million folks too
It is much more powerful to seek Truth for one's self.  Seeing and hearing that others seem to have found it can be a motivation.  With me, I was drawn because of much error and bad judgment on my part. Confronting one's own errors and bad judgment is a very life altering situation.  Confronting the errors and bad judgment of others is usually hypocrisy.


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Gewehr98

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Re: Universal Health Care
« Reply #147 on: November 19, 2008, 10:16:23 PM »
The tone of this thread is disappointing, to say the least.

"Since you're so easily confused..."

"Try to keep up..."

Umm, no.  The thread's outlived its usefulness, and probably well before C&SD began posting text and links hither and yon sans explanation.

As for the others? Well, they're basically talking at each other, and obviously not using their best manners in doing so.  See excerpts, above. 

Put a fork in it, because this one's done.

Next...
"Bother", said Pooh, as he chambered another round...

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