Haves and Have Nots

[Redlass]

Percentages are also strange measurements. There are times when they are very effective measures, other times when it is more difficult to tell what story they are telling.

For example, when I'm bidding on Ebay and I look at the percentage of feedback, I understand that 98% positive feedback on a seller with 5,000 points means a whole lot more dissatisfied customers than a 98% feedback on a seller with only 100 points. It's the same percentage, but it tells two vastly different stories.

Likewise, comparing cancer survival rates of England and the United States don't necessarily tell the story that they appear to. Would it be more accurate to compare England to a state of the same population? I don't know. Maybe, maybe not. I think the difference in cancer survival rates do tell a story, but it's not a place where I would be willing to stop. Rather I'd want to look at the issue more in-depth and try to decide whether it is something we could learn from and improve upon with our greater resources.

As for the difference between government provided and private provided--I have to tell you that I think the education I received from government-provided schools was far better, more comprehensive, and more efficient than the health care coverage I have from a private provider.

I also live in a state where we privatized everything in government that was profitable and efficient and are now struggling with budget woes. Perhaps if we'd kept those things that produced income, we wouldn't have a hard time now providing basic necessary services.

[AuntieEmma[$]]

realtraveller said

Well, I wasn't comparing the U. K. to the rest of Western Europe which has a hodgepodge of various types of healthcare systems.

But that's what the numbers were comparing on the page you pointed to -- the U.K. versus the Western European average, not the U.K. versus the U.S.

But anyway the main point I was trying to make is that the stats you pointed to showed there was a difference in survival rates for men and women. While women in England had worse-than-average death rates from cancer, men had BETTER-then-average rates. And OVERALL (counting both men and women), the death rates from cancer were LOWER in England than average.

So you can't attribute women's lower survival rate to deficiencies in the health care system -- because if that was the case, men would also have a lower survival rate, rather than the higher survival rate they actually have.

Clearly, something gender-related is going on. It jumped out at me, because I'm familiar with the paradox/mystery of the high rates of breast cancer in Marin, a place where people get better health care than the national average, and would therefore be expected to be healthier.

We know that hormones affect cancer in women, and there are many things that can affect hormone levels. I think you have to look at those when you're trying to explain gender-related differences in cancer rates and survival.

[realtraveller]

AuntieEmma said

But that's what the numbers were comparing on the page you pointed to -- the U.K. versus the Western European average, not the U.K. versus the U.S.

Well, some of the figures compared the U. K. to Western Europe but I was quoting from Figure 5.6 (or was it 5.5?) in the article that compared the U. K. to the U. S.

Looking at the figures comparing the U. S. to the U. K., both men and women had worse survival rates for the three types of cancer in the study than in the U. S.

It would be interesting to see figures comparing people who go to the private hospitals in England with the U. S. Presumably, Britons who go to the private hospitals don't have the delays in seeing physicians that those stuck in national healthcare do.

It's hard to find much on this on free sites on the internet. So many articles are on medical subscription sites.

[AuntieEmma[$]]

hymie said

Our Republican mayor here in New York City is proudly campaigning on his record of getting developers to build affordable housing. Who said it was OK not to buy them a house?

And our Democratic (but considered relatively conservative by local standards) mayor is proudly nudging homeless people off the streets and into supportive housing which the government pays for. Oddly enough, it's the more conservative constituencies -- the "Downtown" interests -- that are most in favor of this, as they believe that people lying around on the sidewalks have a bad effect on tourism and other business, and it's the lefties who are saying that the homeless have the right to be left alone.

[AuntieEmma[$]]

Well, some of the figures compared the U. K. to Western Europe but I was quoting from Figure 5.6 (or was it 5.5?) in the article that compared the U. K. to the U. S.

Ok, now I see the chart you were looking at.

(But still what most struck me on that page was this: "Overall death rates from cancer in England for people under the age of 65 years are slightly better than the average for all European Union countries. But that conceals an important difference between genders: while death rates among men are better than average, women have substantially worse than average rates especially for breast and cervical cancers." Which, as I was saying, seems to point to there being some sort of environmental or other cause unrelated to quality of treatment.)

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But even if cancer survival rates are better in the U.S. than in England, overall survival rates for all causes (i.e. total life expectancy) is worse in the U.S. (and the U.S. is also worse than Canada on that measure). Same is true for the infant mortality rate. How would you account for that, if not for the differences in health care systems?

Infant mortality rate: 4.8 per 1,000 Canada. 5.2 per 1,000 U.K. 6.5 per 1,000 U.S.

Life expectancy: 80.1 Canada. 78.4 U.K. 77.7 U.S.

And Japan beats all of them:

Infant mortality 3.3. Life expectancy 81.2

http://www.infoplease.com/ipa/A0004393.html

Who provides health care in Japan?

Japan has a system of universal health coverage, although individuals may receive coverage quite differently. It can be divided into two broad categories: National Health Insurance and Employees’ Health Insurance. Membership in either program is compulsory. According to the Organization for Economic Cooperation and Development, private health insurance is rarely utilized in Japan...

http://66.102.7.104/search?q=cache:n...em+japan&hl=en

[realtraveller]

AuntieEmma said

Ok, now I see the chart you were looking at.


------------------------------------
But even if cancer survival rates are better in the U.S. than in England, overall survival rates for all causes (i.e. total life expectancy) is worse in the U.S. (and the U.S. is also worse than Canada on that measure). Same is true for the infant mortality rate. How would you account for that, if not for the differences in health care systems?

Infant mortality rate: 4.8 per 1,000 Canada. 5.2 per 1,000 U.K. 6.5 per 1,000 U.S.

Life expectancy: 80.1 Canada. 78.4 U.K. 77.7 U.S.

And Japan beats all of them:

Infant mortality 3.3. Life expectancy 81.2

Life expectancy and infant mortality could depend on many factors other than the health system.

You'd have to compare rates of smoking, obesity (that's a biggie for the U. S.), diet, drug abuse, homicide, suicide, alcoholism, exercise and many other potential lifestyle differences in the countries being compared. Life expectancy is also highly dependent on genetics. So you could do comparisons of people of Japanese ancestry living in Japan, Canada and the U. S. and see what their life expectancy was. If they stuck to the Japanese diet, I'd bet their life expectancies overall would be the same as if they still lived in Japan.

Infant mortality depends a lot on the age of the mother, drug abuse by the mother, obesity of the mother, etc.

That's why in comparing health care systems, I'd start with a patient with a lump in her breast. Where was diagnosis fastest? Where was treatment most effective? That way the data isn't cluttered up with lifestyle and cultural differences.

Or on infant mortality compare outcomes for infants born in each country at 30 weeks, or 28 weeks, etc.

The comparisons would be purely on how well does each system cure or treat sick people.

[AuntieEmma[$]]

You'd have to compare rates of smoking ...

Well, look at this. In France, where AFAIK they still smoke like chimneys, the infant mortality rate is 4.3, and the life expectancy is 79.6 -- both better than in the U.S.

The comparisons would be purely on how well does each system cure or treat sick people.

Problem is you have to take into account how many people are getting sick in the first place that wouldn't have gotten so sick if they had more access to routine/preventative care.

[realtraveller]

AuntieEmma said

Well, look at this. In France, where AFAIK they still smoke like chimneys, the infant mortality rate is 4.3, and the life expectancy is 79.6 -- both better than in the U.S.



Problem is you have to take into account how many people are getting sick in the first place that wouldn't have gotten so sick if they had more access to routine/preventative care.

I'm no epidemiologist, but obviously smoking isn't the only cause of death in either France or the United States. It could be that the French aren't as obese as we are, don't have as many MVAs as we do, don't have the high homicide rate we do, etc. etc. And as for infant mortality, any number of factors could be at play.

Obviously routine and preventative care are part of the equation, but I haven't seen any studies that show that people in countries with nationalized health care get more routine or preventative care. In fact, I read somewhere that women in the U. S. are more likely to get routine screening mammograms than in Canada, perhaps due to the waiting lines involved.

Picture one of those villages where everyone eats yogurt, goat cheese and grapes, lives to 100 and the village has one doctor. Using life expectancy as the scale for determining whether the medical system is a good one, one would conclude that this is the best doctor in the world because all his patients live to be 100.

[AuntieEmma[$]]

An increasing number of investors are betting that General Motors Corp., the world's largest automaker, may be forced to seek bankruptcy protection within the next six to 12 months as it struggles to overcome slumping sales and the high cost of health care benefits for workers and retirees.

http://news.yahoo.com/s/ap/20051115/...nkruptcy_fears

[mjfrombuffalo[$]]

There goes my dad's pension.

[Redlass]

There are a whole lot of people who are going to be suffering severely if GM pensions go bye-bye. Many of the people who spent a career on the line ended up with broken bodies and won't be able to find other jobs.