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The US health care wait times myth

theincidentaleconomist.com

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Re: The US health care wait times myth

#11

Post by jdminhbg »

raganwald wrote: post #5
jdminhbg wrote: post #4

Earlier quoted context omitted.

Immigration requires a whole lot of push. Given how many Canadians already live within easy driving distance of the US border, even gigantic differences in efficiency and quality wouldn't drive much actual transnational immigration. You move across a border for a better job, not to potentially shave 45 minutes off your wait time after a putative future cycling accident.

If we were confident that the friction of immigration exceeds the allure of better wait times, then we can say with some confidence that better wait times simply aren't that important to people. Or at least, not as important as making more money, or retiring to a warm place, or hanging out where the action is. If it doesn't rank next to those other reasons for immigration that all exceed the friction, I would suggest…

"If it doesn't rank next to those other reasons for immigration that all exceed the friction, I would suggest that people stop defending the US system by saying it's better than Canada's system. It isn't better enough."

That's fine. I assume the reverse, asserting that the Canadian (and European, and ...) systems are better is also a no-go, given rates of immigration there from the US?

I just don't think anyone's going to move anywhere for health care systems unless they're already sick and they're going for medical tourism purposes. Use of the health care system is a nebulous future possibility, whereas a job or the weather or the cultural environment is an everyday reality. Immigration rates aren't going to tell us much about any health care system.

(edit: specifying the final object)

Re: The US health care wait times myth

#12

Post by [deleted] »

CWuestefeld wrote: post #8

Data point: I live in the USA, and I've got Crohn's disease. I take medicine for the chronic condition, which keeps it in remission 99%+ of the time. But when it flares up, I need to see a doctor pretty quick -- not just because it hurts, but also because the pain is an indication of bad things happening to my intestines. The thing is, I can't get an appointment to my GI doctor right now , or even tomorrow. So I can'…

[deleted]

Re: The US health care wait times myth

#13

Post by Qz »

Groxx wrote: post #6

Interesting article, but can I nominate that last line chart for a worst-graph-colors-of-the-year award? Even after finding out that they are, in fact, different colors it's hard to find any country in it, much less with confidence.

I imagine the colors were chosen so that the US sticks out. It's not a general information chart. It's a god-look-how-terrible-the-US-is chart.

Re: The US health care wait times myth

#14

Post by Qz »

raganwald wrote: post #2

What I find interesting about the "We beat Canada" idea is how few Canadians move to the USA in search of better health care. Rich Canadians take advantage of the porous border by travelling to the US and paying for certain procedures, but generally when someone permanently moves from Canada to the US, it's always in search of economic improvement. I would like to see statistics showing that Canadians would happily t…

I think that's part of the point of the graph. Yes 'we beat Canada' but not by enough that it matters at all.

Re: The US health care wait times myth

#15

Post by CWuestefeld »

klochner wrote: post #7

The author stumbled over one of the most important pieces of data - GP's per 100,000 people. The author notes we have the lowest doctor:population ratio, adding: "And that’s after spending way, way, way more money than anyone else" The problem is that we don't let the market decide on the right number of doctors - the training of new doctors is a function of the number of residencies, which is jointly controlled by c…

I agree with what you said, but there's another dimension as well (as I mention elsewhere in this thread, see http://news.ycombinator.com/item?id=2263931).

We also enforce MDs being the gatekeeper to various medical stuff. Many things we insist must be done by a doctor could be done without that degree. There are certainly a lot of things that someone with the knowledge of a LPN or Army medic could do just fine (say, checking for a broken bone).

And our obsession with (the war on) drugs makes MDs the gatekeeper to pharmaceuticals. Really, there's no reason why most drugs can't be widely available. I understand the logic behind some (like the overuse of antibiotics breeding resistant bacteria like MRSA), but MDs are doing a bad job of preventing that, and in any case, those could be the exception rather than the norm. There's really no reason I shouldn't be able to go to the store and pick up, say, my Asacol on my own initiative.

So the low population of MDs is one aspect, but the overloading of MDs with responsibilities for which their skills aren't needed is another.

Re: The US health care wait times myth

#16

Post by jbooth »

Yeah, I mean I can understand the philosophical place that one could come from that would make one skeptical of government-run anything.

But every other industrial nation beats the crap out of us both in results and in results per $$, while spending far less money. This isn't a theoretical argument -- we could just copy one of those systems wholesale and get way better results than we're getting.

At one point does the engineering principle of "if it works, it works" kick in?

If you saw a better technique for doing something at your business, and didn't do it because "i don't like to see problems solved in that fashion, regardless of what the metrics tell me", you'd be an idiot, right?

Re: The US health care wait times myth

#17

Post by raganwald »

yummyfajitas wrote: post #9
raganwald wrote: post #5

Earlier quoted context omitted.

If we were confident that the friction of immigration exceeds the allure of better wait times, then we can say with some confidence that better wait times simply aren't that important to people. Or at least, not as important as making more money, or retiring to a warm place, or hanging out where the action is. If it doesn't rank next to those other reasons for immigration that all exceed the friction, I would suggest…

But arguments that it's better than Canada should be accompanied by evidence that it exceeds what is actually an incredibly small amount of friction. Very true. Since very few people move from one industrialized nation to another for the health care, we should conclude that they all provide very similar services.

Well, we can conclude that they are not as important and/or as urgent as other factors, and only for those who are mobile. Between Canada and the US, for example, it is easiest to move if you are young, educated, and employable. So I might draw some conclusions about the lack of difference to those who are young, educated, and employable.

I wouldn't assume that there's no difference for someone who is older, uneducated, or unemployed, because the cross-border friction is WAY higher for them.

And of course, all we are talking about is perceived benefit. If one system costs a lot more than the other, we can make all sorts of statements about that. Is the Canadian system more expensive? Is the American system more expensive? I've seen both arguments given, and it looks an awful lot like you can juggle figures at will to justify either claim.

Re: The US health care wait times myth

#18

Post by maxharris »

CWuestefeld wrote: post #8

Data point: I live in the USA, and I've got Crohn's disease. I take medicine for the chronic condition, which keeps it in remission 99%+ of the time. But when it flares up, I need to see a doctor pretty quick -- not just because it hurts, but also because the pain is an indication of bad things happening to my intestines. The thing is, I can't get an appointment to my GI doctor right now , or even tomorrow. So I can'…

So I'm pointing the finger, at least in part, at the regulations here in the USA. By artificially controlling the number of doctors, and/or constraining our access to pharmaceuticals, we're creating the situation where I am unable to get the treatment I need. This has nothing to do with economics or even insurance company policies, really. It's all to do with nanny-state government.

I agree with you! Here's some data about how the supply of doctors is constrained by law:

http://4.bp.blogspot.com/_otfwl2zc6Qc/S8p3XotZRpI/AAAAAAAANQ...

(from http://mjperry.blogspot.com/2010/04/medical-school-grads-hav...)

For the last 30 years, 16,000 new doctors are let through each year, and this is very carefully regulated to keep guild members rich. There's nothing wrong with that, but the problem is that the government is used as a tool to maintain this monopoly. (Unfortunately, it's been this way since the Middle Ages.) Does it have to be this way? Not if you decide that people should be free to choose for themselves which expert they should seek medical help from, and what qualifications they require. If you own your own body (and I say you do), this is your right to decide.

On top of that, new drugs cost somewhere around $1 billion to take to market. When only 300 people in the country have a rare condition, the FDA makes it so that nothing can be done for them because there is no way to recoup a billion dollars from any small group of people.

Re: The US health care wait times myth

#19

Post by CWuestefeld »

zaidf wrote: post #10

My siblings and I take a pill 3x day for life for a genetic condition. The pill(colchicine) cost pennies in its generic form. It isn't a pill that was made in a lab after millions in research. So there were plenty of generic brands available and it'd cost us 5 bucks/mo from Walmart. That was that. Last year a company came in and got an exclusive on it on the premise that they spent millions in testing the pill for qu…

Last year a company came in and got an exclusive on it... There is something seriously flawed about some things in our healthcare system.

That doesn't sound like a healthcare problem. That sounds like an IP problem.

Whatever it was that let the new manufacturer take the compound out of the public domain is where you should be directing your ire. Sounds like another indictment of patent law.

Re: The US health care wait times myth

#20

Post by billjings »

klochner wrote: post #7

The author stumbled over one of the most important pieces of data - GP's per 100,000 people. The author notes we have the lowest doctor:population ratio, adding: "And that’s after spending way, way, way more money than anyone else" The problem is that we don't let the market decide on the right number of doctors - the training of new doctors is a function of the number of residencies, which is jointly controlled by c…

That it's general practitioners is the key data point there - it's not talking about physicians in general. We have a far greater ratio of specialty doctors to general practitioners than other countries do.

I don't have the stats handy, but from what I've read I'd be surprised if we didn't have more doctors per 100,000 people than the average country.

edit: Here's the stats - http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physi... - they bear out my statement, but not really my argument. We have more doctors per 1,000 people than Canada; less than Germany.

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