A Day In The Journey

These are all good points. I chose the life expectancy stats due to the fact that typically poorer quality of care (including waiting an extended amount of time for what turns out to be an emergency procedure) would adversely affect those statistics. Life expectancy statistics take into account access to health care as well as the diseases prevalent as the data are being compiled, so they do account in some measure for health care and would be a reflection (in general) of poorer quality care. (Two interesting articles on life expectancy in the US: ; ) Further, life expectancy has a distinct correlation with poverty levels (International Journal of Epidemiology abstract; ; abstract of Cornell U study). Poverty levels lead not only to greater stress factors, but a typically a lack of medical care (Medicaid coverage arguably not extending far enough up the income ladder to make up for income disparity in the entire working class.).

Here are some mortality statistics to flesh out the LE statistics:
deaths from circulatory disease
*We tie with the UK.
overall deaths from cancer
*We are statistically higher than the UK by almost 70 people per 100,000.
This despite a higher rate of cancer treatment success as I noted in the post. The reason for this is probably due to those who are uninsured or underinsured delaying treatment or not seeking treatment. I don’t actually have statistics to back up the discrepancy b/w cancer treatment success rates and a higher rate of cancer deaths overall, that’s just my surmise.
deaths from heart disease
*We are lower than the UK by 16 per 100,000. A small per capita betterment, probably due in part to increased awareness of heart problems and more common screening.
maternal mortality rate
*Interestingly, our maternal mortality rate 1 higher per 100,000 than the UK.
probability of reaching the age of 65 or above for males
* The UK has 4% higher probability.
same stat for females
*The UK has 3% higher probability.
--this is likely due to the much greater focus on preventative care and health maintenance fostered by a program where the out-of-pocket cost of said preventative care and maintenance is largely nil. Thus, general health problems are caught early, dealt with early, and managed while still minor. Here, people often avoid the GP (interestingly, we have a far lower rate of GPs than most European countries due to the prestige and lucrative salaries of specializing which does make it harder to see a GP for preventative care.) and wait until they are symptomatic then see a specialist.
male mortality rate per 1,000 male adults
*We rank 144th from the highest, the UK ranks 171st. In other words, out of 193 countries noted, they rank 27 nations better than us.
--Mortality rate is defined as the probability of dying between the ages of 15 and 60, ie. the probability that a 15 year old will die before reaching the age of 60.
WHO mortality rates
*Notice that we just don't top the list here. (Although, it does seem that Germans have some serious cardiovascular issues....)
article discussing what life expectancy and adult mortality rates mean

Now, as far as wait times in a nationalized system, I picked the UK since it has what would most likely be the model used if we ever adopted a single-payer system: a nationalized health system that also has a flourishing small, secondary private market. Canada tried for a long time to eliminate the private market altogether which seems to have caused more harm than good, a trend it is now trying to reverse.
NHS report on waiting times
*Note: this is the wait time between being referred to a specialist by a GP and beginning actual treatment (ie all prelim tests have been done and discernable treatment is begun with the specialist). Patients in the UK see their primary care physician (GP, which we really have too few of here—a change that should be made and is addressed in the WH proposal.
more NHS wait time figures.
And here is an incredibly good article comparing some basics in health care wait times: Commonwealth Fund comparison
*You’ll notice that the numbers for seeing a specialist and the numbers for seeking elective surgery in the UK aren’t great, but these are 2005 numbers, and the previously linked NHS reports show the decrease in the following four years.
And our wait time record is getting worse.
Again, this has somewhat to do with a lack of focus on GPs and preventative care as well as delaying treatment causing more extensive and immediate treatment, all issues addressed in HCR.
Businessweek article regarding increased wait times in the US (author also relates part of the problem to not enough GPs which is a focus of the WH HCR proposal).

Small aside:interestingly, having a scheduling consultant teach hospitals new ways to view and handle scheduling could make an incredible difference in wait times even with the increased patients that HCR might bring into the system on a regular basis.

As far as an increase in inefficiency goes, it would be very difficult to make comparisons here. All I can really say about that is:
1) the transition here is largely one of how private insurance premiums are paid. In other words, doctors will still largely be paid by private insurance just as they are now except now the risk pool will be substantially larger, premium payments will be subsidized for those who cannot afford or struggle to afford them, insurance companies will compete on an evened playing field where consumers can compare plans easily (as opposed to the incredibly complex and varying way they have to be compared now--can someone say "standardized terms, please" haha), and there will be federally standardized minimum coverage expectations to even out the bottom line on coverage.
2) the US military has a completely nationalized health care system that seems to work fairly efficiently. Yes, there are exceptions where care standards have been ignored until attention was paid, but that's typically the exception and not the rule.
3) bringing complete single payer into the picture would actually simplify paperwork for the most part (exempting the private health coverage and care system that would likely exist alongside as it does in the UK).
4) there was some other point I had, but while I was typing the first one, I forgot. I just wanted everyone to know I had a really great fourth point that vanished into the maelstrom that is my mind right now. :-P It had something to do with overhead and advertisement and Medicaid/Medicare and something something. If I ever remember it, I'll put it in later. haha.
Bonus: the UK has a really interesting service that allows you to find and compare health care services as well as choose a provider and book an appointment. This would seem to suggest that in some ways nationalization could actually increase efficiency. /bonus.

The WH has addressed in general this fear of increasing the deficit. The CBO also reported (and I don't have the link to the report summary on me right now--it's probably on the WH site somewhere. This WaPo article is the closest I can get you currently.) that over time, HCR would actually lower government spending and the deficit. This has a lot to do with the fact that HCR would lower and slow the growth of health care costs over time. Because the FG ends up spending a significant of money on health care and coverage already (largely in emergency ways--covering uninsured in the emergency room, etc.--and thus less efficiently than through HCR), lowering and slowing the growth of health care costs has a significant impact on the deficit projections. If that makes sense. Frankly, if we really want to deal with the deficit (a deficit that we have had for almost the entirety of our history and has been significantly worse in comparison with the GDP, btw), we should focus and raise efficiency on defense spending. It's currently quite inefficient now. And I'm a hawkish type person, so this isn't about fighting or not fighting wars, but prioritizing defense spending. Anyway, that's a slight rabbit trail, but the bottom line is, the deficit will be far greater down the road if nothing is done about health care costs and coverage now, even with the initial cost outlay. I think it's a relevant and significant point here that the NHS in the UK was established in 1948. For 62 years, the UK has managed to run an almost completely nationalized health care system (I found that roughly 8%-11% of health care/coverage is through private funds, largely as a supplement to NHS services). Although HCR here is not looking to nationalize health care in any way (aside from an expansion of Medicaid), the fact is that it can be done without bankrupting the country. I suspect there are similar findings to be had regarding Australia and Germany, etc., but I'm about statisticed out. hahaha.

As far as funding abortion goes, the Hyde Amendment basically prohibits federal monies from funding abortions. The only way that might be considered changed in this situation is that subsidy money could be applied to premiums for plans that cover abortion services. Yet, federal job salaries could be used to pay for the premiums of plans that cover abortion services. There has been suggestions of having abortion services coverage be an unfunded rider (eg, it's an addition, like maternity coverage, but the insured would have to pay for that part of the premium on their own). For me, the inclusion of plans that cover abortion services in the insurance exchange and the use of subsidies to pay the premiums of plans that might also cover abortion services is not a huge deal. Granted, I think that HCR should include good contraceptive coverage, thus minimizing the issue in the first place; but, given the small percentage of persons to whom this situation would even apply, and given that anyone who receives any federal salary could use that money for abortions or insurance that covers abortions, I think the Hyde Amendment limits this enough. This isn't like the FG suddenly offering to pay for everyone's abortions with taxpayer money all the time. This is merely that some people might purchase insurance that covers abortion services and those premiums could be subsidized. As far as I know, this doesn't even affect current Medicaid policy. I know for some people, it's a huge issue, but I think this is a case where a mole hill is being made into a mountain. That is, of course, merely my opinion. I don't expect everyone to see it (or any of this, for that matter) the way I do. :-)

And yes, those articles are looooooong. But they are so, so good. Seriously. If you only read one, read the one about McClaren, Texas. It's quite informative and really important to understanding the issues behind escalating health care costs. They are ridiculously long, though; I won't argue with you there. haha.