Talk:Health care in the United States

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[edit] Why I reverted the article to the last good version by Dhakk

Some anonymous idiot (who refuses to create an account and log in) keeps editing out certain key points about why Americans are so wedded to their current health care system, dysfunctional as it is.

The point is that whether one agrees with free-market libertarianism or not (or its academic companion, the law and economics school), or the conclusions drawn by its adherents, it is a major factor in the internal politics of the United States.

Like the flawed concept of race, it is like a self-fulfilling prophecy in the circular sense that it still matters because people take it seriously, and people take it seriously because it matters. Therefore, it needs to be mentioned in any serious discussion of anything that affects the American economy, including healthcare (which as we all know is a huge component of American GDP).

Yes, I will personally concede that perhaps some of the fears of libertarians are exaggerated, but for better or worse, libertarianism and the political consequences of its views are dominant in the U.S. and should be incorporated into any serious discussion of American economic issues, especially healthcare. Otherwise, a neutral student of these issues will not be able to understand what the hell is going on when they are trying to comprehend the crazy American healthcare system (and the last time I checked, enlightenment is a major goal of an encyclopedia).

--Coolcaesar 00:53, 19 Jan 2005 (UTC)

Why would people want to keep a system that is overly regulated because it is more "libertarian"? Are you trying to say that the U.S. has a free market in health care and that is why people want to keep it? As far as I can tell the U.S. government spends more on health care than almost any other country and the industry is so regulated that people are shielded from the actual costs which drives up prices in the long run. What exactly does our system have to do with libertarianism anyway? --Jayson Virissimo 21:20, 27 July 2007 (UTC)

[edit] Articles needs to be NPOVed

elaborate please....

This article has a lot of useful information about the U.S. health care system, but it needs a good NPOVing (made neutral in point-of-view) as it's rather slanted against the methods of managed health care. Bumm13 15:12, 12 May 2005 (UTC)

I think the outline has gotten rid of NPOV problems I am going to remove that in a few days/Mrdthree 13:43, 15 July 2006 (UTC)
Slanted? How can lack of health care for millions be a neutral issue?! How can people going bankrupt because they have cancer be a neutral issue either?
Generally, uninsured statistics represent a snapshot. Many uninsured people are reinsured in less than a year; The same people are not uninsured year in and year out. And what makes you think a National Healthcare system would fix the money problem for cancer patients, et al? National Healthcare would make medical services seem free, which pushes demand beyond what this county can currently supply. Govt's deal with that by limiting what's available, hence less cancer care for everybody. Less cancer care means higher fatalities overall. Joe Christl (talk) 15:48, 19 February 2008 (UTC)


Screw HMO's and the sociopaths that run them. Sean7phil (talk) 19:18, 15 January 2008 (UTC)

This article sounds like it was written by socialists. Please correct it towards a more NPOV immediately!! Joe Christl (talk) 15:48, 19 February 2008 (UTC)

[edit] With Bumm13, I agree, but disagree

I agree with Bumm13 that this article needs to have its "ranting" quality restrained. But I feel it was, as are all Wikipedia articles comparing the US and Canada, slanted (tremendously) in favor of the Canadian institution. I guess it's to be expected, considering the European/Canadian left-wing-dominated contribution to Wikipedia. -Justin T.—The preceding unsigned comment was added by 65.33.245.150 (talk • contribs) 09:03, 11 June 2005 (UTC).

You have got to be kidding, correct? Have you been to the Clinton page at Wikipedia? It rehashes every single nutcase right-wing-radio allegation ever made against Clinton. Meanwhile, Wikipedia's entry for George W. Bush carefully sanitizes his record (and could well have been written by Karl Rove).—The preceding unsigned comment was added by 71.86.119.156 (talk • contribs) 22:50, 6 June 2006 (UTC).

[edit] Oh noes!

All these bad people preventing the glorious GOP to expand his bright ideas ... —The preceding unsigned comment was added by 82.231.37.93 (talk • contribs) 12:16, 22 June 2005 (UTC).

[edit] ah.. if only we could cut the tube and spend all this money to buy land for national parks ;)

[edit] Feb 2006 economist magazine

Economist had an analysis of USA health care this month. They claim that currently USA taxes pay more than 60% of health care bills as govenment heavily subsidize employers insurance. In future, this will be 100% covered by taxes as Ford situation forces employers to bail out of the health quagmire.

In short, the whole thing is very similar to UK or French system only the way the money is handled differ. UK and French passes the money directly to the health industry. USA first pass the money to employers who then hand it over to health industry.

Please, don't stone me for saying this, just get a copy of the above paper and pass your disagreement to that author—The preceding unsigned comment was added by Wk muriithi (talk • contribs) 20:16, 7 February 2006 (UTC).

[edit] Re: Feb 2006 economist magazine

do you have the title of that article from the economist? I can't find it in the archives.

thanks a lot—The preceding unsigned comment was added by 128.178.52.209 (talk • contribs) 17:06, 17 April 2006 (UTC).

It's actually the issue of January 28, 2006:

  • Leader, "Health care -- America's headache (How to start fixing the world's costliest health-care system)."
  • Special report, "America's health-care crisis -- Desperate measures (The world's biggest and most expensive health-care system is beginning to fall apart. Can George Bush mend it?)."

--EnOreg 16:07, 7 June 2007 (UTC)

[edit] America is populated by 200 million communists!

Congressional comitte finds 2/3rd of yankee wants guaranteed basic health insurance coverage. Such an ungodly idea, the land of the free braves will be turned into a euro-monkey socialist limbo. This is the beginning of the end of USA! See and fear:

http://www.cnn.com/2006/HEALTH/06/07/universal.coverage.ap/index.html

Your post is so weird that I'm not sure if you're actually seriously afraid of universal healthcare or you're making fun of such people. Well, either way, your post is hilarious. --Coolcaesar 16:35, 9 June 2006 (UTC)
Some libertarians think that mandatory universal health insurance is the best possible compromise. see reference 6. Mrdthree 19:06, 10 July 2006 (UTC)

As a disabled veteran who has free healthcare for the rest of his life, I can say I wish I had private healthcare. The federal healthcare system may be free, but unless you are literally dieing at that very second, it can be very difficult to get an appointment. I just moved to Texas and I'm having to wait four months just to see a doctor so I can be assigned a primary care physician. Until then, I cannot get my prescriptions refilled. The profesional quality of the medical staff is also lacking. Like with many federal programs, it seems to be that the doctors who can't make it in the private sector are the ones who end up contracted by the federal government. If the government is incapable of providing a high standard of healthcare for 1% of its citizens, I can't imagine how anyone expects the entire population to be covered. --Teram10 19:50, 18 March 2007 (UTC)

You may want to look into what the current Administration has been doing with the VA healthcare budget for a partial explanation of why the VA is the way it is. MastCell Talk 23:36, 18 March 2007 (UTC)
That's nonsense, because the VA healthcare system has had problems for decades. I remember both my grandfathers' complaining about the system, and that was when I was a kid.--Teram10 07:17, 21 March 2007 (UTC)
Sounds like breaking a vase and saying it was already cracked to me. The Walter Reed Army Medical Center neglect scandal, and Washington Post: "Veterans Groups Critical of Bush's VA Budget" provide good examples of what has gotten worse. Of course the vase already was cracked, and more still needs to be done to fix the system.. --68.21.94.56 22:51, 13 August 2007 (UTC)
I doubt you'll ever see a capitalist system providing exemplary socialized services. T.C. Craig 19:58, 21 August 2007 (UTC)

[edit] Restructuring Article

The article is an essay I think it has good structure but is low on facts and long on prose. I want to offer a more elaborate outline:

1. Healthcare Providers (Who Provides it) (1.1)Private (1.1.1)Services and Facilities (1.1.1.1) Outpatient Services (1.1.1.1.1)Service Providers (1.1.1.2) Inpatient Services (1.1.2)Pharmaceuticals Medical Devices (1.1.3) Medical Research (1.1.3.1) Commercial Research (1.1.3.2) Non-Commercial Research (1.2) Government (1.2.1)Local (City, State, County) (1.2.2)Federal (1.2.3)Research Institutes (1.2.3.1)NIH (1.2.3.2)NIMH

2. Health care payment (who covers it) (2.1) Private (2.1.1)fee-for-service (out of pocket) (2.1.2)Insurance (risk management) (2.1.3) Managed Care (2.1.4) Charitable (2.2)Government (2.2.1)Local (2.2.1.1)state programs (e.g. Dirigo health insurance in Maine)-(2.2.2)Federal (2.2.2.1)Medicare, Medicaid) (2.2.2.2)Free emergency care

3. Healthcare Regulation and Oversight (3.1) Public Health Institutions (3.1.1) CDC (3.2) Healthcare Regulators (3.1.3.1) FDA

4. System Inefficiencies and Inequities (4.1) Inefficiencies (4.2) Inequities

5. Regulatory Inefficiencies and Inequities (5.1) Inefficiencies (5.2) Inequities

6. Political Issues and Controversies (6.1) Universal Healthcare (6.2) Prescription drug coverage

I am only going to use 3 levels of outline at most. Mrdthree 19:01, 10 July 2006 (UTC)

I like the outline, but the section entitled "Segmented medical billing and records" does not contain any citations:
The billing process is also considered by critics to be inefficient.[who?] It is argued to be wasteful for the following reasons:[citation needed] The lack of a national identity card forces insurers to impose many bureaucratic procedures like ‘’pre-authorization’’ of non-emergency procedures upon both providers and patients to guard against fraud; The insurers have a financial interest in denying coverage for any reason, and providers and patients have a financial interest in fighting denials of coverage, and both end up wasting time and money in the process; The extreme fragmentation of the entire industry forces all entities to waste a lot of time learning about each other's bureaucratic procedures, because of the low probability that any pair of provider and insurer will regularly encounter each other; and Much of the health care industry still operates on inefficient paper documents, because no entity outside the federal government has the market power to impose a single standard for digital ransmission of health care information, and the federal government has been unable to create such a standard as of 2005. The process of selecting the appropriate billing code for each procedure completed has become so intricate that there is an entire industry of clerks devoted to it (complete with its own professional association, the American Academy of Professional Coders.
-AED 03:55, 13 September 2006 (UTC)
I removed the above section. It may be true, but lack of references mean it fails to comply with WP:V. -AED 00:13, 19 September 2006 (UTC)
I am not sympthetic to national health care but I think who ever wrote that has a point. If there were national healthcare there would be only one payor. That should at the very elast simplify records and paperwork. Having worked in a law office, I can attest to the volume of bills a patient will get repetitively from multiple sources. It would probably elimimnate alot of paper at the very least. This is reasearchable-- how much is spent on collections or administation? Mrdthree 00:24, 19 September 2006 (UTC)
National healthcare does NOT imply one payor. Germany and France both have national healthcare but it is a multipayor system. Study up on European health systems to see the variety that works there. --Chrispounds 12:21, 27 October 2006 (UTC)
I AM in favor of national health care, but it seems that the only examples politicians point to in the United States are Canada and the UK, which do have single-payor systems (though in Canada, each province has its own system). Chrispounds is right; single-payor is not the only way to provide universal care. Australia and New Zealand provide universal care through a mixture of public and private sources, though New Zealand's is closer to single-payor.--MarshallStack 19:02, 17 April 2007 (UTC)

[edit] universal healthcare

ive heard that masachusets is the closest thing to universal healthcare. are there any other info out there on what other american states have universal healthcare or something close to it —The preceding unsigned comment was added by 86.132.229.24 (talk) 23:23, 6 December 2006 (UTC).

I heard maine Mrdthree

Nowhere in the United States is everyone covered.--MarshallStack 19:04, 17 April 2007 (UTC)

Actually, the US has universal healthcare, or shall we call it universal sick care. Medical facilities and doctors are licensed by union like collectives like the AMA with conformance mandated by the government requirements on license to practice. The condition of licensure mandadates that all required healthcare services be provided once in the door regardless of ability to pay. Cases where hospitals have dumped patients on the street because they can't pay are being prosecuted under such laws.

What the US doesn't have is a system of paying for required and recommended healthcare that does not ration the care by ability to pay or social class. Only safety net is the mandated care when death is threatened.

The issue is how care is paid for and rationed, not whether care is universal. Mulp 18:43, 23 September 2007 (UTC)

It seems that published, verifiable sources use the terms "universal coverage", "universal health care", and "universal health insurance" somewhat interchangeably. Regardless of what term they use, they invariably say that the U.S. does not have this. EMTALA requires only that patients entering an emergency room receive a health screening and "be stabilized," regardless of ability to pay. If this was sufficient to meet a baseline for "universal health care", why would emergency physicians be among of the strongest advocates for moving toward true universal health coverage?[1]-- Sfmammamia 03:43, 24 September 2007 (UTC)
Why are sugar farmers among the strongest advocates for sugar subsidies? Only the most ethical businessmen oppose subsidies for themselves.JoeCarson 12:36, 25 September 2007 (UTC)
JoeCarson, there are two flaws in your response. First, it took me about two seconds on Google to discover that sugar producers actually oppose sugar subsidies.[2]. Secondly, you should know that "advocate" and "oppose" are not the only options. There's also neutrality or silence. If the current system was effectively delivering "universal care," emergency physicians would be satisfied with it. They are not. The U.S. system is obviously not delivering universal care, and all international comparisons by verifiable sources make this clear. -- Sfmammamia 17:58, 25 September 2007 (UTC)


What Google do you write of? I find sugar farmers supporting direct subsidies for themselves and restrictions on their foreign competitors. If they opposed these, that would just indicate that they were ethical, not that there was any flaw in that part of my argument. You make the fatal assumption that emergency room physicians choose their political views on health care based on what will provide universal coverage. As a businessman providing service/product x, universal use of x may not necessarily be how I decide what the government should do about the x industry. If I was unethical, I would lobby for the government to pay for x for everyone, and to do so at the price I decide. But an ethical businessman would want to keep x unrestricted, even if it meant lower profits. JoeCarson 18:55, 26 September 2007 (UTC)
With regard to sugar producers, the link I referenced above was to an alliance of sugar producers stating why they oppose sugar subsidies. Perhaps you missed it. If sugar producers meet this standard of ethics, why are you so unwilling to see how physicians might also? Especially since, in the past, medical groups have been so adamant about limiting government involvement in health care. Perhaps the change is due to the multibillion dollar losses created by EMTALA, an unfunded mandate, which is an indication of how far from "unrestricted" U.S health care already is. Mulp's assertion further up this discussion that EMTALA has effectively created a universal safety net was where this particular thread started. My point was that EMTALA, by itself, does not meet international standards for universal care, and the people closest to delivering emergency care know it. And by the way, universal care does not necessarily equal government payment; perhaps it might help you to read that article? -- Sfmammamia 21:04, 26 September 2007 (UTC)
I do not doubt that you have found sugar producers who oppose these subsidies, but from what I know of American sugar farmers, the strictly ethical farmer is a minority. I was not trying to insinuate that the U.S. has universal coverage. My point was merely that unethical (or ignorant) physicians would lobby for more government coverage even if there was basic universal coverage. I understand that universal coverage can be achieved without coercion, but empirics have yet to confirm that part of the theory. You should read American Medical Association and perhaps research that organization further. Many physicians only oppose government involvement when it hurts their bottom line. They are often happy to accept subsidies and restrictions on their competition. JoeCarson 22:25, 26 September 2007 (UTC)

[edit] Vandalism

Just today I removed 3 phrases found in the intro that were clearly vandalism. Phrases like "so much bloody GDP", "Big Mac" and "So Fat"

Please watch this article closely. —The preceding unsigned comment was added by 131.96.221.68 (talk • contribs).

[edit] VA Hospitals

Why is the Veterans Health Administration left out of this article as if it doesn't exist? The article claims all health coverage is provided by private organizations but this is incorrect. Both federal and state hospitals do exist in the United States. —The preceding unsigned comment was added by Teram10 (talk • contribs) 19:43, 18 March 2007 (UTC).

Brief mention of the VA has been added. -- Sfmammamia 23:08, 13 August 2007 (UTC)

[edit] Removed false statement in intro paragraph

In the first paragraph this statement was made:

The United States spends the highest percentage of health care costs on pharmaceuticals in the world.

I looked at the reference where this fact comes from and read this:

Over the past decade, the share of health expenditure spent on pharmaceuticals in the United States increased from 8.6% of total health spending in 1993 to 12.9% in 2003. This remained below the OECD average of 17.7%. In 2003, the United States was the top spender on pharmaceuticals (with 728 USD per capita, adjusted for purchasing power parity), followed by France, Canada and Italy.

Maybe I'm a moron but it sounds to me like the United States spends the largest number of raw dollars on pharmaceuticals but in fact a less than average percent of total health care costs.

Anyway, I reworded this statement to instead say this:

In absolute currency, the United States spends the most on pharmaceuticals per capita in the world. However, the share of expenditure on pharmaceuticals accounted for only 12.9% of total healthcare costs, compared to a world average of 17.7% (2003 figures).

This is truer to the reference than the original wording. Emach 15:47, 1 June 2007 (UTC)

[edit] Laughable statistics

This line in the article sounds highly dubious: However, another survey, released in 2004 by the National Center for Health Statistics estimated that approximately 70% of Americans were in "excellent" or "very good" health.

Nearly two out of three adult Americans, 60 percent, are overweight or obese.[1] How does that translate to "excellent" or "very good health"?? The "National Center for Health Statistics" sounds like it's being asked to spin the truth by the government.

They are probably comparing health to the world at large which includes African countries with life expectancies of 40.--JEF 15:01, 30 June 2007 (UTC)
Actually, it's an interview survey, so it's Americans rating their own health. Hence the obvious skew. I've updated the wording and inserted the latest stat, which was just released this week. --Sfmammamia 18:27, 30 June 2007 (UTC)

[edit] Question about some content

I was reading the part about Services under Health Care Providers and I wasn't sure if this was appropriate: "In 1996, concierge medicine emerged, where enhanced care and services are provided by primary care physicians for a retainer fee." 69.232.71.55 05:50, 6 July 2007 (UTC)

[edit] Debate section should be deleted or moved.

This section has nothing to do with the US health care system. It belongs in a section on the pros and cons of universal and nonuniversal coverage. I'd suggest it be deleted.--Rotten 05:34, 15 July 2007 (UTC)

The consensus if you look at Talk:Health care is to leave the debate section here because it is a US-centric debate, but it is well sourced. It is an important part of a any discussion of the US health care system and thus needs to be included for a complete article.--JEF 20:48, 15 July 2007 (UTC)

Actually the consensus was for an unmerge so I went ahead and followed your Rotten's suggestion.--JEF 23:46, 15 July 2007 (UTC)

It should be remebered that whoever merged the debate removed alot of content from other parts of the article and inserted it in the health care debate section. Mrdthree 04:30, 16 July 2007 (UTC)

[edit] Under-insurance

I read somewhere recently that many people in the US who believe that they have adquate health insurance are often found to under-insured when they come to make a claim. Unfortunately I can't recall where I read it. I presume these under-insured people are included in the statistics for "insured" people. I just scanned the article for a reference to under-insured but cannot find anything. Is there an editor here who knows that source and can add it as a statistic and can give a reference?--Tom 00:50, 11 August 2007 (UTC)

Good suggestion — I found a fairly recent Health Affairs study on underinsurance and added it under "Coverage gaps". The study doesn't exactly match your comments, so it may not be what you read, but it introduces the topic, and perhaps other editors can tweak or add accordingly. -- Sfmammamia 15:37, 11 August 2007 (UTC)

[edit] Numbers of Uninsured

The census bureau reduced its estimate of the number of uninsured mentioned in the article from 46.6 million to 45.8. http://www.census.gov/Press-Release/www/releases/archives/health_care_insurance/009789.html

Judyjoejoe 18:52, 28 August 2007 (UTC)

:Corrected. -- Sfmammamia 19:10, 28 August 2007 (UTC)

The Census Bureau's 2006 report was issued today, and the number of uninsured is now at 47 million, so that figure and all other details found in the report have been updated to reflect the 2006 figures. -- Sfmammamia 01:03, 29 August 2007 (UTC)

47 million are currently uninsured, or for at least one day during some period of time, or ... ? The answer seems to be basically that the Census Bureau doesn't really know, but: "Compared with other national surveys, the CPS estimate of the number of people without health insurance more closely approximates the number of people who are uninsured at a specific point in time during the year than the number of people uninsured for the entire year." http://www.census.gov/prod/2007pubs/p60-233.pdf (Sidebar, p. 18, and Appendix C, p. 57) Brec 18:21, 26 October 2007 (UTC)

The 2006 report issued in Aug. 2007 (see cite just above) reflects 2005 data w/r number of uninsured. -- Brec 18:24, 26 October 2007 (UTC)

Brec, I just checked the August 2007 Census report. See page 18, first highlight, which says "Both the percentage and the number of people without health insurance increased in 2006. The percentage without health insurance increased from 15.3 percent in 2005 to 15.8 percent in 2006, and the number of uninsured increased from 44.8 million to 47.0 million." All charts and tables in the August 2007 report also state they include 2006 data. --Sfmammamia 19:00, 26 October 2007 (UTC)

[edit] What happens to the sick un-insured?

I am not a US citizen and I am curious about something that does not seem to be explained in the article. If a baby is born in the US to a person who is not insured and the baby is born with congenital defects requiring expensive medical procedures to ensure the baby can live, what in practice happens?

Also, what arrangements are there in the US for severly disabled young people who, for whatever reason on reaching maturity, are unable to work and therefore afford to buy insurance? I understand that hospitals will always provide emergency room treatment for the uninsured, but many people have chronic illnesses needing constant care and medication. What happens to these people? Are they just left to suffer and die?? I can't believe that is allowed to happen, but maybe I am wrong. Children cannot choose their own parents!--Tom 10:16, 31 August 2007 (UTC)

From my experience, if a person has a chronic medical condition and they cant get a job that will give them insurance they have to become poor so that it is covered by Medicaid. This usually means working occasionally on the books and working under the table (which usually pays less). I imagine a family would have to make similar arrangements.Mrdthree 11:13, 31 August 2007 (UTC)


There is also a supplemental social security program that provides income for those who for some reason cannot work. This program is not limited to seniors like the standard social security package. For children, there is the SCHIP program which has expanded to include many middle class children in addition to the poor children it was intended to cover. The U.S. government spends more per capita on health care than most nations that have "socialized" medicine. JoeCarson 14:07, 31 August 2007 (UTC)

In the first instance you mention, a baby is born and needs expensive medical treatment, in practice what may happen is that the parents will receive hospital care that may be written off by the hospital as charity care or supported through some charitable group. There's no guarantee of this, of course. Parents who don't know how to navigate this type of crisis could just as likely get stuck with the bills and undergo bankruptcy to escape them. -- Sfmammamia 14:44, 31 August 2007 (UTC)
Hospitals in the USA are required by law to save a patient's life if they can, no matter if the patient can pay or not. Thus the baby in your example would receive treatment, and the parents would get billed later. If the parents can't pay, the hospital would either try to negotiate a lower bill, or cancel the bill, or send its lawyers after the parents, forcing them into bankruptcy. It depends on the hospital. As for severely disabled young people, most of them would be elligible by Medicaid, but that depends on the state. The ones who aren't elligible (a relatively small number) usually end up on the street and are left to fend for themselves, especially if their disease is not life threatening. If their condition deteriorates, they seek treatment in emergency rooms, recover for a while, get thrown back on the street, return to the emergency room, and the cycle continues until the die. Ever wondered why there are so many homeless people in America? Most of them suffer from severe mental illness, but are not elligible for treament in mental hospitals. Cambrasa (talk) 19:40, 22 February 2008 (UTC)


OK thanks, everybody. Its heartening to hear that people are not left to die, but the financial stress that these people and their families must go through (over and above that of the illness itself) must be awful. I am sure, that nobody in Europe for example would ever face bankruptcy due to ill health or birthing a child with a severe congenital defect. Universal health coverage with co-ordinating social policies would absolutely protect families and individuals from the stresses of that kind. Medicaid sounds a bit like the hated poor law in England before the beginning of the modern welfare state, when it was widely recognized that that a law designed to protect the poor was actually responsible for pushing people into poverty (see http://en.wikipedia.org/wiki/Poor_law#The_reform_of_the_Poor_Law and for how the poor law provision emerged into the modern health serices in the UK see http://www2.rgu.ac.uk/publicpolicy/introduction/health.htm#Development).

Perhaps the article should be extended to cover the issues of poverty, stress and chronic ill- health. I'll resist the temptation to get involved in this myself but hopefully some other editors could pick up the matter. To me, as someone outside the US, this is quite a shocking feature of the US system. --Tom 19:56, 31 August 2007 (UTC)

Here's a starting point: a March 2007 study that documents the obvious: people who are uninsured receive less care and have worse outcomes following an accident or the onset of a new chronic condition than those with insurance. [3] -- Sfmammamia 20:34, 31 August 2007 (UTC)
That is interesting. There is also a certain inadequacy of most international comparative data put out by the US press (both popular press and the medical press) about treatment outcomes in the US compared to other countries using other systems of health care. These tend to focus on things like wait times and the so called misery and risk associated with waiting, rationing and the implications of prioitizing patients according to health priority rather than access to finance, and medical outcomes for those that get treatment. They also tend to refer to raw numbers that alone are not really meaningful ... e.g. the number of MRI units per capita. But this type of comparison actually ignores all those people who do not get access at all and does not measure meaninful issues like the amount of suffering (including stress and worry - not just pain) in the populations as a whole. That ill-health can lead to bankruptcy is quite shocking.
Actualy, I don't share your perception that international comparisons are skewed in the press. The WHO 2000 rankings as well as the 2007 Commonwealth Fund six-nation comparison [4] which ranked the U.S. poorly on most of the criteria it addressed, have picked up a lot of coverage in the U.S. I don't believe the Commonwealth Fund study has been referenced in this article, but it's linked into at least a couple other healthcare articles on Wikipedia. I'll add it as an external link for now, perhaps it should be incorporated somewhere within the article? -- Sfmammamia 15:45, 1 September 2007 (UTC)
Maybe its because I keep following links placed in Wikipedia that lead to articles by people from pressure groups and so called think tanks like Cato that in my opinion distort the truth. Some of these articles are, sadly, picked up by respected newspapers. If publicly funded health care in the UK was as bad as they say, there would be a greater take up of private medicine and political pressure to replace the system. In fact quite the opposite happens. --Tom 15:05, 2 September 2007 (UTC)
Ever heard of irrational bias? People believe silly things when they don't understand the complexities (or even the basics) of an issue. Look up dihydrogen monoxide. JoeCarson 12:39, 25 September 2007 (UTC)

[edit] Society's values - "everyone for himself" versus "lets look after each other"

I see that when data comes up indicating that the US has worse health overall (life expectancy, infant mortality, obesity, diabetes, coronary heart disease etc) then we are told that this data is not comparable because of lifestyle, death from crime etc. But health is inexctricably linked to poverty, stress, sex and food education, food balance, and having time, money and motivation to use fitness facilities. Public policy in Europe addresses all these things, but they seem to be much less of a priority in the US. As an outsider, it seems to me that for most people, health care in the the US, like so many other things, can be summed up as "everyone for himself" whereas, in Europe for example, its more, "lets look after each other". Its a gross over-simplification of course, but I think it contains a core truth. Recognizing how society is organized and affects health care requires a huge shift in perception of the issues because it does not focus on those things that appear to be to the fore at the moment (i.e. how to widen access to health care and how to control spiralling costs). It may be difficult to introduce these issues into an article on health care in the US, but actually I do think they are significant. --Tom 08:02, 1 September 2007 (UTC)

Perhaps you should think of it as "live and let live" vs. "do as daddy says". Americans are more likely to engage in unhealthy behavior, but it is not within the purview of government to snatch the big mac from your mouth. As far as poverty is concerned, each country has a different definition. Someone living in "poverty" in the U.S. often has the same wealth and purchasing power as someone who is considered middle-class in Europe. JoeCarson 11:06, 1 September 2007 (UTC)
To JoeCarson. I did say it was an over-simplification and your opposite view would be held by some in Europe too, but not a majority. Your final statement is quite remarkable. Where is the evidence for it?--Tom 11:59, 1 September 2007 (UTC)
In the economic literature. If you have access to a university library, it should be relatively easy to find papers that measure poverty in nation x and provide a definition. Ab initio, it is quite obvious that this should be true but the empirics you seek are out there. JoeCarson 10:54, 2 September 2007 (UTC)
Poverty is a very relative thing and defititions do vary, but I absolutely refute your statement that the poor in America are have the same purchasing power as the European middle class. It is so obviously wrong! I see that you have not actually attempted to prove the point. The onus my friend is on you to prove the statement you make. I do have access to a university library but will use it only if you can give a direct reference. --Tom 14:12, 2 September 2007 (UTC)
I'm not here to hold your hand. You have not refuted my arguments, only rejected them. If you're too special to type in a few words into Google scholar, perhaps you should not deign to be a lowly wikipedia editor. JoeCarson 17:29, 2 September 2007 (UTC)
For both of you, even though this is off-topic, a single reference shows how the U.S. can be both the richest country and the poorest: according to this international comparison of 20 relatively wealthy, industrialized OECD countries, [5] the U.S. has both the highest per-capita income and the highest rate of poverty (17%). "At the bottom of the income scale, US poverty rates are higher and living standards are lower than for those at the bottom of comparable economies. Moreover, income mobility appears to be lower in the US than in other OECD countries." By the way, the comparison includes Finland. Income inequality is higher (no surprise there) and the growth of average real compensation is below the OECD average. -- Sfmammamia 20:20, 2 September 2007 (UTC)
An interesting set of data. Actually its right on topic (for this section of the talk page anyhow). In essence I think it demonstrates how re-distributive tax and social benefits work in some countries to reduce poverty and improve access to things such as health care whereas in other countries the preference is clearly not so redistributive. "Everyone for himself" versus "Lets look after each other" is another way of looking at it. That is not to say the US way is wrong ... it's a political choice. National income per capita can be skewed for by some odd factors... for instance Norway's income is skewed by high government revenues from oil... it does not necessarily mean that average household earnings are that high, but many of the benefits come back to people by good social benefits such as health care, child care, and other social infrastructures. Here in Finland, young adults for example receive free university, college or professional training and even receive a "salary" or living allowance (not a loan)during their study years. But of course taxes are higher than in other countries. There is no such thing as a "free education" or "free health care". Someone pays for it somewhere.--Tom 20:57, 2 September 2007 (UTC)
While I believe that it is fine for each nation to have their own definition of poverty, there are huge problems with international comparisons. Poverty lines are often drawn at 60% of median household income, but 60% of median will mean vastly different things in different countries. Imagine if Mexico and the U.S. had the exact same relative standard deviation of income (and perfectly Gaussian too). Poverty in Mexico and the U.S. would be measured as identical using that definition. I've been to Mexico, it's not East Africa but the average Mexican does not live as well as the average poor American. The U.S. also has high immigration from Latin America (my parents are an example). These new immigrants are often poor by American standards but quite well off compared to how they lived before. This increases measured poverty, but that poverty is only temporary in most cases. JoeCarson 10:04, 3 September 2007 (UTC)
Actually I agree that varying defintitions make comparisons difficult and you may be right about Mexico. I read somewhere elses that spending more than a third of disposable income on food was another defintion used in the US. But I am sure that if you take the lowest 10 per cent income strata of European society and compare their lifestyle to the lifestyle to the lowest 10 per cent strata of American society you will find that on basic necesitities of life such as health, housing, food, and education (for the young of the poor), Europeans will come out on top. I am not saying that to be boastful. It just happens to be true because of income distribution and social policies. It's costly of course and it certainly depresses the disposable income of the middle and higher income earners. I think the social scientists would say that there is higher income mobility in European society. Why do the European middle and upper classes willingly pay taxes support the basic needs (including health) of the very poor? I think the answer may be the high rate of poverty before the creation of the welfare state. Many people now in the middle classes were children of the lower working classes who knew how fine the line was between the working poor and the abject poor. The working poor in many cases supported the abject poor before the welfare state was created, but such coverage was patchy. The present system is at least fairer and less humiliating than the system that preceded it. Europeans do not have to join welfare programs, claim special status for services (e,g, medicaid) or use food stamps. There is less "shame" associated with being poor in Europe. But its no fun either. Life is tough, but manageable. Europeans have a much smaller crime rate than the US and only a tiny per cent of the population in prison. There are mostly no vagrants and people do not find themselves in so bad a poverty trap that they cannot emerge from it or else suffer terribly if they do not. I guess thats the pay off for the tax payers supporting the less well off. --Tom 18:44, 3 September 2007 (UTC)
I agree somewhat with what you write. Because of the smaller variance of income in Europe and the magnitude of maldistributive policies, Europeans in the bottom x% are likely to have a better standard of living than their American counterparts. 10 sounds about right for x. However, Americans in the top (100-x)% have a better standard of living than their European counterparts. If x < 50, then the U.S. has the more equitable social policy. Americans generally have more regard for those citizens who make the greatest contribution to society, so our upper-middle class is quite well off in comparison to the upper-middle everywhere else. Why should we be forced to subsidize those citizens who do the least to better our society? If Europeans freely choose to do so, that's fine, but those who do not vote to subsidize the poor should not be forced to do so.


As far as crime is concerned. No one likes to admit that the relatively high crime rate in the U.S. is due to our greater diversity. White Americans are actually a bit less criminal than their counterparts in other Anglo countries. JoeCarson 10:36, 4 September 2007 (UTC)
Tom, the themes that you mention, "everyone for himself" versus "let's look after each other" come up quite strongly in Michael Moore's film, Sicko, so the shift in perception that you describe is already occurring among the millions who have seen the film. -- Sfmammamia 15:34, 1 September 2007 (UTC)

[edit] Do more profits mean more investment?

Since we are discussing theory (see above; equity, US vs. EU) heres a theory: I have been trying to think about what positive outcomes may come about from the fact the US spends more money per capita on healthcare. I came up with a theory. Grant that the difference in spending is primarily a difference in profits for insurance, medical device and pharmaceutical companies. In some theories, Company profits drive new investment to a market. So I was wondering is there evidence for more healthcare R&D in the US? (what measures are there? can this be decoupled from academic funding?) If there is a benefit, is it proportional to the excess that individuals payout in the US Healthcare system relative to other systems? If the evidence is mixed, what areas benefit, what areas seem to lag relative to other countries? Is this a concern of the healthcare system article? Mrdthree 19:53, 4 September 2007 (UTC)

The U.S. does invest more in R&D than Canada, but I'm not sure how it compares to Europe. Investment of profits only makes sense if it creates more value for shareholders than the alternative of returning those profits to them in the form of dividends. Americans are suckers for the latest greatest method of measuring x or treating y, so I imagine that investment would be greater here than in Europe where the health care market is much more restricted. Governments do not act like rational shareholders.JoeCarson 22:04, 4 September 2007 (UTC)
I think you'll find that health research is done all over the globe and everyone is looking for a cheaper or more effective way of doing things. Research is done either where it's cheaper to do so or where the expertise is. If there is money to be made from finding a cheaper or more effective way of doing things, someone will attempt to do it and make money from it no matter where they are in the world. I have heard the argument put that cutting spending in the US will harm R&D investment in the US and that the US proportionaltely spends more on health research but I haven't actually seen any hard evidence to back that claim. I'd be glad if someone can point to any academic research on the issue. I assume you mean medical R&D JoeCarson. One would expect it to be higher in absolute terms but what about relative to GDP? What is the source for your statement? A lot of research is university based so I'm not sure how that can relate to company profitability. --Tom 16:42, 5 September 2007 (UTC)
I am going to collect some articles to try and navigate my way into the numbers I want.
  • "Venture Capital Investments In Healthcare Industry Lag" (2000)[6]
  • "A disciplined approach to capital today's healthcare imperative"(2007)[7]refs[8]
  • "National Health Spending In 2005: The Slowdown Continues"[9]
  • goodplace to stop[10]
Mrdthree 14:26, 18 September 2007 (UTC)
Key articles
  1. "Trends In Health Care R&D And Technology Innovation"(1996) [11]
  • gives breakdown for private and public healthcare investment for 1986-1995; 1995: Industry:52% (23B in 2006 dollars) Private nonprofit:3% State and Local:6% NIH:33% ($14B in 2006 dollars) Other Federal: 6%
  • Government’s share of total spending on health research fell from 53.2 percent in FY 1986 to 44.2 percent in FY 1995
  • Sweden, the Netherlands, and Canada have centralized technology assessment agencies, evaluations in the United States are conducted predominantly in the private sector.
  1. "Innovation In Medical Technology: Reading The Indicators"[12]
Article names several indicators of medical device innovation: public- and private-sector research and development (R&D) investment, patent activity, product regulatory clearance patterns,and market acceptance trends.
Mrdthree 16:12, 18 September 2007 (UTC)
NIH stopped producing annual estimates of national support for health R&D by source and performer (including state and local government funding) after 1995, when it discontinued publication of its annual Data Book.[13]
US R&D expenditures generally 1980-2006 [14]
the data can be painfully assembled at least to 2003 by industry: private/state vs. federal [15] and state data is available here [16]. Im not going to do it though.
Phrma is an american pharmaceutical industry association that publishes investment stats (not healthcare generally).[17]
annual Pharma R&D: NIH funding decreased from 2004-2007 while industry funding increased at about 5% per year (in constant dollars, my calculation using inflation calculator [18]. NIH NUmbers: $30,$29,$28b, Phrma R&D:$39.5 $41.2 $43b In that time, 77-80% of R&D was done domestic and 70-73% of revenues were domestic.[19]
Thus the ratio of NIH:INDUSTRY funding, 1995-->2006 is pretty much unchanged 1.5-1.6. all numbers are my estimates.Mrdthree 15:20, 19 September 2007 (UTC)
INternational stats from canada [20]
SUmmary: US is third in R&D per capita, fourth in R&D: domestic sales ratio. Switzerland (Roche, Novartis), and Sweden are ahead of US. UK ( Glaxo,Astra-Zeneca) is ahead in case 2. However these measures are weak, because they do not say how much og the Swiss, swedish, and UK R&D dollars come from sales in the US market.Mrdthree 16:22, 19 September 2007 (UTC)
I think its fair to say that european pharma is in decline, especially in R&D:"Data for 2005 and preliminary figures for 2006 confirm the vulnerability of Europe’s research-based pharmaceutical industry. Benchmarking and performance indicators show Europe’s relative lack of attractiveness for pharmaceutical R&D investments."[21] Mrdthree 17:33, 19 September 2007 (UTC)
Prior to 2001, europe was the primary source of pharmaceutical innovation. from 2001-2006 the US was the primary source of new medicines. From Canada's report, the countries that have higher R&D dollars are net pharma export countries, teh US is the main market for EU exports (35% of all export sales). 37% of EU drug imports come from Swiss, 44% from US []. Total EU r&D at 22b euros in 2005. growth rate of EU R&D spending vs. US R&D spending 3.5% vs. 7.7% (likely no adjustements for inflation). 47% of pharma revenues come from US. 66% of world new drug revenues come from US. 76% of world biotech revenues come from US market, 34% of biotech companies are located in teh US. 15% of world biotech revenue comes from EU, 38% of biotech comapnies in EU.[22] all stats from european pharma association [23]Mrdthree 17:13, 19 September 2007 (UTC)

The easiest way to answer the healthcare investment question is to look at industry association data. IN the US there is Phrma, in europe there is EFPIA. For longer term stats on the US there is the NIH report [24]. It could be worth looking at Japans data too. Mrdthree 17:39, 19 September 2007 (UTC)

[edit] Economic Overview of Health Care System

I was trying to think about where to put investment info on teh US healthcare system and I dont want to put more stuff in the intro. Then it hit me. Maybe this article needs a section on the finance and economics of the health care system. Doing economic facts in wikipedia is great for private investors, and maybe breaks the political history orthodoxy of encyclopedias. Either that or link it to a see also about the Healthcare system as industry. Possible section titles: Economics of Health care system, Economic Overview.., Mrdthree 15:38, 21 September 2007 (UTC)

Actually there is a Health care industry page (unexpanded) and there is also a Health economics page (political economy and theory not really an attempt to deal with industry finance as it exists). Maybe I will go work on the Health care industry page and eventually this section should have an economics overview section with a see also to Health care industry for details of the financial state of the health care industry and companies? Mrdthree 15:46, 21 September 2007 (UTC)

[edit] Objective measures?

In this paragraph the "effectiveness" of US health care is rated

The debate about U.S. health care concerns questions of access, efficiency, and quality purchased by the high sums spent. The overall performance of the United States health care system was ranked 37th by the World Health Organization (WHO) in 2000, but the same report assessed Americans' overall health at 72nd among 191 member nations included in the study.[7][8] However, the WHO study has been criticized by conservative commentators as biased because it marked down countries for having private or fee-paying health treatment and rated countries by comparison to their expected health care performance rather than objectively comparing quality of care.[9] Furthermore, most Americans rate their own health as "excellent" or "very good". The National Health Interview Survey, released annually by the Centers for Disease Control's National Center for Health Statistics reported that approximately 66% of survey respondents said they were in "excellent" or "very good" health in 2006. This percentage has been declining since 1998.[10]

Unfortunately it read like a "he said she said" paragraph. There is no reason we couldn't add in objective measures, such as life expectancy, infant mortality, death in maternity, and so forth. All of these measure put the US above most third world countries and below most first world countries and they have the advantage that they are raw figures. Sad mouse 16:17, 15 October 2007 (UTC)

[edit] number of uninsured who are illegal aliens

I deleted the statement recently added to the lead asserting that 12-16 million of the uninsured are illegal aliens. This is a completely unreliable number that does not agree with the Census Bureau's estimate, which is the source for all the other general statistics on insurance and the uninsured used in the lead. According to the Census Bureau, a little over 10 million of the uninsured are non-citizens, but this does not distinguish between immigrants who are here legally or illegally. So the number of illegal aliens represented in the total of uninsured has to be less than 10 million. I will add this detail further down in the article; I don't think it's necessary to add to the lead. According to the Census Bureau, more than 36 million of the uninsured are native citizens and naturalized citizens. --Sfmammamia 15:25, 18 October 2007 (UTC)

Non-permanent visa immigrants are legally obligated to have health insurance while they are in the country, so you can discount them.

From this article http://content.healthaffairs.org/cgi/content/abstract/24/6/1640 - 68 percent of undocumented workers lack health insurance - 17 percent of native-born - 23 percent of naturalized citizens - 38 percent of green-card holders Oddly enough I can't find the number of Green card holders anywhere, but the estimate of undocumented workers is 12 million http://en.wikipedia.org/wiki/Illegal_immigration_to_the_United_States This would give 8 million uninsured undocumented workers. Sad mouse 17:12, 18 October 2007 (UTC)

[edit] Spam magnet - please add this template to your watchlists

New template {{Healthcare}} seems rather promotional (naming specific companies while excluding others), and might bear watching. Adding a promotional link to this template would have the effect of quietly spamming one's company name into many healthcare articles (currently 12) without any indication appearing on history pages to raise suspicion. --CliffC 04:40, 24 October 2007 (UTC)

I deleted the template Template:Healthcare and I do not believe this template explains Healthcare facts, this template explains healthcare policy options. It is more appropriate as a template that links together pages discussing the political plans of recent political candidates. Mrdthree 09:57, 24 October 2007 (UTC)

I like the new placement of the template, but think it may need a new title. Mrdthree 03:43, 25 October 2007 (UTC)

[edit] Cost of regulation

This document http://www.cato.org/pubs/pas/pa527.pdf, written in 2004, claims that regulation in the US health care system costs annually some $339 bn (at 2002 prices!). It seems an incredibly large number, way over a $1000 per person per annum at 2002 prices and probably closer to $1500 today. $6,000 on red tape every year for a family of 4 seems incredible. Does any editor here know what action has been taken to verify these costs and/or reduce them? It does seem to be a very high burden on American enterprise. --Tom 23:16, 30 October 2007 (UTC)

Note that the Cato analysis itself says "The uncertainties in these figures are considerable, reflecting a combination of gaps in knowledge as well as large methodological differences across studies in terms of how to measure costs and benefits." Needless to say, Cato has a definite bias and its analyses are not peer-reviewed. Peer-reviewed health economics sources that address this subject would certainly improve this article, but I don't have access; anyone else? --[[User:|Sfmammamia]] 00:30, 31 October 2007 (UTC)
FYI Sfmammamia, I found another dodgy statistic that seems to be sourced from another group with a similar bias. This time the topic is cancer recovery rates rather than regulation. The claim is that recovery from prostate cancer is much better in the US than under socialized medicine in the UK. The source ia apparently the Manhattan Institute and its writer David Gratzer. Rudolph Giuliani has used the statistic in his presidental campaign advertising to criticise socialized medicine, but the statistic's interpretation is flawed. There are more details at http://en.wikipedia.org/wiki/Talk:Socialized_medicine. As a writer on medical matters I thought you might be interested and/or may know if this misleading use of statisitics has been raised more widely recognized in the US´media. --Tom 09:18, 2 November 2007 (UTC)

[edit] Do we need a section on spending levels?

I just saw an interesting CBO report on technological change and health care spending. I'm looking for a place to put it, and noticed that we don't have a section on spending levels and trends. Since the cost of health care is a key factor driving a lot of the problems/pain/political debate/etc. in the U.S., it seems like a section on it might be useful. We touch on a few of the issues in the "Inefficiencies" section, but never really do much with it.EastTN (talk) 15:25, 4 February 2008 (UTC)

[edit] Disparity of Coverage and 'Low' Importance

There needs to be a section on sexist discrimination causing disparity of insurance coverage and other issues for men vs. women and straight vs. gay. In particular, women's health issues have historically been shoved back to second-class, back-of-the-bus and continue to be discriminated against. For example, 1) women only recently won the right to insurance coverage for reconstructive breast implant after mastectomy, 2) it took an act of congress to get the right, and 3) it is still only covered for a single mastectomy to restore symmetry, essentially forcing women to undergo surgery with all its risks especially general anesthetic, infection, cost, (not to mention the terrible food) twice in order to retain cosmetic appearance whenever a double mastectomy is indicated, whereas viagra for erectile dysfunction was covered immediately. Also, abortion clinics have been firebombed and doctors who perform abortions have been shot and killed.

Another sexist disparity arises in coverage of psychiatric medical problems. All health insurance that I am aware of discriminates against the mentally ill with separate and grossly unequal benefit levels for psychiatric care. This is particularly egregious in the case of transsexuals, who are by definition mentally ill, yet often find themselves paying for all health care related to relieving the distress of transsexuality out-of-pocket, often amounting to tens if not hundreds of thousands of dollars, and leaving them vulnerable to victimization by a small clique of unscrupulous providers who take advantage of the social stigma against transsexuality, abandoning patients to die when surgical complications arise on the expectation that transsexual patients will not be able to sue for lack of access to legal representation.

I also disagree with the rating of the importance of this article as 'low'. Only healthy people would rate this article as 'low' importance. Everyone gets sick and dies eventually. It is shortsighted to wait until one is on one's deathbed to finally awaken to the tragedy of 2X cost, 1/2 benefit health care in the US as compared to the rest of the industrialized western world. It also is insane to rank the issue as low importance when millions of employed people die every year for lack of any insurance coverage of any kind at all and US health statistics are so far behind other nations with half the cost, particularly at a time when overpopulation and growing scarcity of world resources threaten to choke off the stunning economic growth in the US that has historically relied on ready access to cheap oil and cheap foreign labor (at least within the past 50 years). —Preceding unsigned comment added by 66.245.216.254 (talk) 12:13, 14 February 2008 (UTC)

[edit] Connecting discussions of delayed treatment and coverage gaps

Earlier today I added the new study by the American Cancer Society. Sfmammamia did some nice editing. She also moved it (for reasons I do understand). I'd put it in the section entitled "Coverage gaps," at the end of a paragraph reporting on a study that claims many people with private health insurance have inadequate coverage, and that as a result they forgo health care (along with other bad things). The ACS study reported that people with private health insurance have cancer diagnosed more quickly than people who are uninsured or who have Medicaid. It seemed to me directly relevant to the question of whether people with private insurance are receiving inadequate health care. Sfmammamia moved it to the section entitled "Delays in seeking care and increased use of emergency care" which discusses how the uninsured often don't get the care they need.

I don't argue that she shouldn't have put it there - it's certainly relevant to that issue. I do still think it's relevant to the general question of "underinsurance" as well. If nothing else, it does suggest that private coverage gives people better access to cancer screening than Medicaid (or being uninsured). We could just put a sentence back in under "Coverage gaps." But more generally, this made me start thinking about whether there's some way that the two discussions should reference each other. The basic argument that's often raised under the "underinsurance" rubric is the idea that private coverage isn't good enough and effectively leaves people unprotected and unable to get the health care they need. Somehow the discussion that insurance doesn't provide the coverage people need should be informed by the parallel discussion that people are better off if they're covered. We could just put a sentence under each referring to the discussion on the other, but I'm wondering if there's a better and more appropriate way to do this.EastTN (talk) 19:32, 19 February 2008 (UTC)

I think I like this particular paragraph better in the delayed treatment section, but yes it also added something to the coverage gaps section. I don't think it would be too objectionable to add a redundant sentence or two. However, I do think we need to add something about the pitfalls of comparing Medicaid performance to private insurance because, as the existing sources point out, many patients on Medicaid are only enrolled after they become sick, which also may explain why they are diagnosed at a later stage than those with private insurance. Nathanaver (talk) 22:30, 19 February 2008 (UTC)
I agree that we need it in the delayed treatment section, and Sfmammamia has done a good job of expanding it for that purpose. You bring up a good point about the comparison to Medicaid (though I suspect that says more about the limitations of Medicaid's outreach than it does about the quality of private coverage). I'm not as familiar with that issue as you seem to be - is this something that's more prevalent for certain eligibility categories, such as adults or the disabled? It's been several years since I've looked at it in any detail, but my impression was that Medicaid spending levels per capita for children and non-disabled, non-elderly adults were not all that high compared to people with private coverage.EastTN (talk) 22:48, 19 February 2008 (UTC)

[edit] Expanding criticisms of WHO statistics in the body of the article

Sfmammamia, I dropped that new reference in up top simply because I wasn't sure where else to put it (which isn't, now that I think of it, an especially good excuse). I'll be glad to try and flesh it out below - do you have a suggestion for where it should go? I didn't see it as worth a new subhead, and didn't see an immediate home for it. EastTN (talk) 15:58, 11 March 2008 (UTC)

I'm thinking we may need a new section head -- probably placed between "Health care regulation and oversight" and "System inefficiencies and inequities" that would be called something like "Overall system effectiveness" or "Outcome comparisons" or "International comparisons" or something like this. I think we need a place to put an expansion of what currently constitutes the third paragraph of the lead section. Any of those section heads sound right to you? --Sfmammamia (talk) 16:26, 11 March 2008 (UTC)
That makes sense to me. I like your first suggested heading, because that's the real issue - international comparisons and outcome statistics are just ways of getting at how well the system is working. EastTN (talk) 16:45, 11 March 2008 (UTC)
Great. Now all we have to do is write it! Would you be willing to take a stab at it? --Sfmammamia (talk) 17:07, 11 March 2008 (UTC)
Sure - it may have to be tomorrow, though. EastTN (talk) 17:13, 11 March 2008 (UTC)

[edit] Official Statistics on US Healthcare Expenditures from Oct. 2007 - March 2008

Could anyone please provide for the latest statistics on the United States Healthcare expenditures? Is there a source to reference for updated information on a monthly or quarterly basis? Thank you in advance for your information. Regards. —Preceding unsigned comment added by 68.173.10.181 (talk) 18:00, 28 March 2008 (UTC)

Take a look at the section entitled "Health care spending." The first paragraph talks about the national health expenditure projections published by the Centers for Medicare and Medicaid Services (CMS) - "National Health Expenditure Data: Overview." That's perhaps the most official estimate for national spending on health care that you can find. EastTN (talk) 19:03, 7 April 2008 (UTC)

[edit] Do we need an article on the Uninsured in the United States?

I'm looking at a KFF study on the impact of an economic downturn on coverage levels and the Medicaid and SCHIP programs, and trying to figure out where to put it. It could go in this article, in the Health insurance in the United States article, and in both the Medicaid and the State Children's Health Insurance Program articles. We have stuff on the uninsured both here and in the Health insurance in the United States article, but no one place where it's all drawn together. It would seem helpful to have an article that summarizes the current research on the uninsured, including their demographics, research on the reasons for lack of coverage (e.g., can't afford insurance, don't qualify due to health status, don't think they need it, or whatever), the health and economic impacts, and the programs designed to address the problem. It might also shorten some of these other very long articles. Would something like that make sense? EastTN (talk) 19:49, 29 April 2008 (UTC)

[edit] Congress

How is the health care system of the members of the Congress ?. --Mac (talk) 06:07, 10 June 2008 (UTC)

[edit] The same Government that wants to run your health care, wants to privatize their own kitchen

Think about it ! See http://www.liveleak.com/view?i=1ba_1213125506 . 79.210.101.114 (talk) 21:05, 10 June 2008 (UTC)