(04-01-2014 10:41 AM)Max Power Wrote: Sorry Owl. I don't have the time to read through the 200 page report now, but I'll get to it this weekend. I very well may be wrong in using the word "despite." If so, that still doesn't do much to convince me that our system needed fixing. Looking at your list, Canada is ranked 7th to our 15th even before taking into account we spend 17% of our GDP on health care to their 10%. I do thank you for your thoughtful response.
So, let me get this straight. You don't have time to read 200 pages, so you can't look at the summary tables that pull it all together. But you did have time to find an innocuous passage on page 26 and pull it out of context to support a completely false interpretation--and one that would have been obviously false if only you'd bothered to look at the overall methodology discussion--or the summary tables. You got caught in a lie, Max.
As for Canada ahead of us, remember the ranking at that point was 2/3 equality and 1/3 quality, and on that basis a system where everybody gets bad care is going to finish ahead of a system where some get good care and some get bad care. That's been one of the principal criticisms of the study.
When you take a balanced look at all the studies, a fair summary would be as follows: Universal systems do a better job of keeping healthy people healthy. Fee for service systems like ours do a better job of treating sick people. In a population-wide study, the impact of better preventive and routine care for all outweighs the impact of better care for the truly sick, because statistically there are so few truly sick people, and this effect is magnified when cost is factored in because it costs a lot more to treat sick people than it does to keep healthy people well.
That pretty well suggests the ideal--a universal basic care system to provide routine and preventive care to everyone, and a fee for service system--with insurance--to care for the truly sick. That in a nutshell is Bismarck, which is why the Bismarck systems consistently outperform the others in comparative studies. The one downside to Bismarcks is that they cost more than centralized systems--but that's because they are actually treating sick people instead of sticking the in a queue.
There is one other factor to consider. The centralized systems (single-payer and single-provider) that work best are those in countries with very small populations. You can make single-provider work up to about 10 million. The Nordics prove that. Beyond that, the anticipated economies of scale have a nasty tendency to become diseconomies of scale. The burden of administrative overload simply kills all efficiency.
