France is healthcare leader, US comes dead last: study


France is tops, and the United States dead last, in providing timely and effective healthcare to its citizens, according to a survey Tuesday of preventable deaths in 19 industrialized countries.

The study by the Commonwealth Fund and published in the January/February issue of the journal Health Affairs measured developed countries' effectiveness at providing timely and effective healthcare....[more]

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The 19 countries, in order of best to worst, were: France, Japan, Australia, Austria, Canada, Denmark, Finland, Germany, Greece, Ireland, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, the United Kingdom and the United States.

Interesting to note that the United States is the only industrialized nation that does not have a universal health care system and there we are at the bottom of the list in healthcare.
Tell me again why a universal coverage won't work here?

How much will taxes rise if there is Univ. Health care ?

Don't you know your taxes already cover a lot of catastrophic health care for people who don't have insurance or other coverage, and who wait until the inevitable worsening of conditions lead to an emergency, and then you pay TOP DOLLAR for their care at that time?

You're already paying for socialized medicine in the USA. You SHOULD be asking INSTEAD how much your taxes would go DOWN once preventive care puts a stop to the huge expense of emergency care.

Penny wise, pound foolish! ... that's the truth of health care in America.

Doesn't Canada have pretty high taxes too? Why would you think that taxes would go down?

1. Canada has been bitten by the Corporate Elitism bug about as badly as America. A big chunk of their funding plans is missing since corporations are avoiding more and more Canadian taxes. That's missing revenue. True to form, these holes get filled as far as it can from overburdening those who can't evade taxes -- the working laborer and Capitalist. The working class and small-business class end up with the distinct impression that their taxes are "too high". If corporations paid as the legally should have paid, those two classes would not have that impression.

2. The current system of backdoor-socialized-medicine has to pay for (1) an overabundance of emergency care, (2) the profit needs of the entities involved. Say what you want about that, but that all sounds expensive to me. Making care accessible for PREVENTIVE purposes should be tried just to test that theory. After all, the USA is #1 in the world for PER CAPITA health care spending. We ALREADY spend the most by all applicable metrics. So, why WOULDN'T changing that system result in less of a tax burden? The cost is supposed to go DOWN by implication.

We've spent gargantuan amounts on a stupid war that is largely just a way of continuing the excesses of the Cold War which lined the pockets of the military-industrial complex. There went an entire system of socialized medicine, literally up in smoke, as another flagrant mis-spending on elitism over citizen care. Why do you THINK about 40% of your income disappears into the coffers of government each year?

would be a great resource for this.

are we last because of the small percentage in improvement? The article doesn't explain the rankings... If it's just the 'improvement' (or lack thereof) that puts us at last place, maybe we were already good to begin with and there wasn't as much room for improvement as in other countries? I don't know...

but it does say that the survey was based on preventable deaths...but doesn't explain what those 'preventable deaths' were. Personally, I've never known anyone who could prevent death (lol)...however, I'm curious if preventable deaths include such things as heart attacks due to preventable causes, like high blood pressure?

I wish there was a link to the actual study so I could look up the answers...

update: found the study, but it's not available without a subscription...only the abstract and press release are...

Yeah, lets just open up the hospitals to free health.

I have family in Canada in the health care profession. There are a lot of rural areas in Canada with very small hospitals where simple care can be treated. When there is something major, most of the time the patient needs to be transported by ambulance to a major city hospital which may be hours away. There is a doctor and nurse shortage in Canada because no one wants to work the rural hospitals because the staff is limited making the hours suck and the pay suck more so these qualified Doc's and nurses go to the major cities leaving the rural hospitals on their own. Also people are turned away at the rural hospitals for minor things and referred to their primary care physician. Also rural hospitals in Canada are closing.

Because of free health care Canada turned into a nation of hypochondriacs.

Yeah, lets not forget Canadian's are taxed 35% and more on income then another 15% sales tax.. Free health care sure lowered their tax. Way to go !

We have a shortage here are well. Have you ever noticed the number of foreign docotors and nurses we have here in the US?

Why don't we just extent Medicare coverage to everyone? Healthcare providers could and would still remain private owned. I work in the healthcare field, and I can tell you that most complaints from patients are in regards to their private insurance coverage, not Medicare. And from a provider prospective, private insurances often reimburse at a lower rate than Medicare anyway. So with private insurance, you pay more for it, and yet they don't reimburse more. And it not like their getting better care since the providers are the same for Medicare and private insurances. What's wrong with this picture?

You must not deal with Medicare a lot. I hear a lot of complaints about it.

And there are pockets of locations where people don't even have access to a doctor who will accept Medicare. (One specific location I can recall is certain areas of Washington state, the others I can' t remember off the top of my head...but I used to work handling issues for retirees all across the country and I got a *lot* of complaints about Medicare. Anyhow, the doctors in those areas I referenced withdrew from the Medicare program because of the reimbursement. One lady in Washington state I talked with had to drive 2 hours each way just to see the closest doc who would take Medicare.)

I never said there weren't complaints about Medicare--only more complaints about private insurers. Of course less doc's will withdraw from Medicare if reimbursement keeps getting cut, but that problem could easily be solved if you transfer the waste of private insurances into funding Medicare. Consider this stat:

"At least $286 billion, enough to cover all of the uninsured and to provide full health care coverage for everyone in the United States, is annually spent on paperwork by competing insurance companies."


I've heard some people (possibly on this forum even?) say "why not model a universal health plan after Medicare?" And they don't always get it when I try to explain why that wouldn't be a good idea. (Of course, someone who doesn't have firsthand experience with Medicare...either as a beneficiary or from the providers side...doesn't realize that there are problems w/Medicare too.)

If we're going to have a universal health plan, its going to have to be a totally different design. The Medicare model wouldn't work for it. (For starters, Medicare doesn't cover much in the way of preventative services. That certainly wouldn't work on a universal level.)

I am saying "why not model a universal health plan after Medicare?" This doesn't mean "copy" the plan. But the model is in place, it would just need some changes.

If by "some changes" you mean completely overhauling and redesigning 60-70% of the plan, then sure...let's use the Medicare model with "some changes." ;)

The biggest problem that Medicare has is that it works. Republicans can't stand the fact the a government program can be successful; so they keep cutting it.

Ask a pharmacist what they think of the new Medicare drug program that is administered through private insurance companies. They'll tell you it a cluster **ck.

Medicare Faces Cuts in Bush Budget
$36 Billion Cut Could Face Tough Sell in Congress

Feb. 6, 2006 -- Medicare could face another $36 billion in cuts over five years under a budget proposal unveiled by President Bush on Monday.

The cuts would come mostly in the form of reduced payments to hospitals, nursing homes, and other health care providers. But they would also be a part of a savings package that could increase Medicare premiums paid by some seniors.

...own report:

"The financial outlook for the Medicare program continues to raise serious concerns. In particular, a “Medicare funding warning” is triggered by the findings of this report. Total Medicare expenditures were $408 billion in 2006 and are expected to increase in future years at a faster pace than either workers’ earnings or the economy overall. As a percentage of GDP, expenditures are projected to increase from 3.1 percent in 2006 to 11.3 percent by 2081 (based on our intermediate set of assumptions). Growth of this magnitude, if realized, would substantially increase the strain on the nation’s workers, Medicare beneficiaries, and the Federal Budget.

HI tax income is estimated to fall short of HI expenditures in 2007 and is projected to do so in all future years. The HI trust fund does not meet our short-range test of financial adequacy, and fund assets are projected to be exhausted in 2019. In the long range, projected expenditures and scheduled tax income are substantially out of balance, and the trust fund does not meet our test of long-range close actuarial balance. Currently, this imbalance is relatively small, with tax income is estimated to cover 99 percent of costs in 2007, but will grow rapidly in the absence of changes to current law: taxes would cover 79 percent of estimated costs in 2019, and only 29 percent at the end of the long-range period. Closing deficits of this magnitude will require very substantial increases in tax revenues and/or reductions in expenditures."

SensorG - not sure about your definition of 'works', but a program that is not sustainable doesn't match my own definition....

Regardless of the value of the program or whether or not it works, even the trustees of the program say it's in serious trouble..

I like much of the Concord Coalition's take on these issues...

The Center on Budget and Policy Priorities has some interesting points in regards to this report:

[The financing problems] primarily stem not from the nature of the Medicare program itself, but rather from the continuing sharp rise in health care costs throughout the U.S. health care system, in the public and private sectors alike. For the past 30 years, the increase in costs per beneficiary in Medicare has been nearly identical to the increase in costs per beneficiary systemwide. As David Walker, the Comptroller General, has emphasized, “[F]ederal health spending trends should not be viewed in isolation from the health care system as a whole. For example, Medicare and Medicaid cannot grow over the long term at a slower rate than cost in the rest of the health care system without resulting in a two-tier health care system….”

So if Medicare and Medicaid are growing at slower rates than private insurances, does that mean private insurances are in BIGGER trouble? It continues:

Inefficiencies in Medicare’s payment policies are worsening the program’s financing problems. Congress’ expert Medicare advisory commission (the Medicare Payment Advisory Commission, or MedPAC) has found that Medicare is overpaying private insurance companies more than $10 billion per year, and the Congressional Budget Office reports these overpayments are weakening Medicare’s finances and accelerating the date of Medicare insolvency.

So is this more of an issue of mismanagement? Overpayments of $10 billion per year to private insurance companies? $70 billion giveaways to drug companies? Medicare is just like any other gov't program---it's not that it doesn't work, but if you mismanage it then it will suffer. FEMA comes to mind....

The biggest problem that Medicare has is that it works. Republicans can't stand the fact the a government program can be successful; so they keep cutting it.

Bingo. They can't possibly get rid of it as quickly as they want, because it's far too popular among seniors. So instead it's death by a thousand cuts. If they keep building up the debt, it provides them with a perfect opportunity to cut Medicare. The continual cuts lead to fewer benefits, lower reimbursements, etc. Next thing you know, people are telling anecdotes about elderlies who have to drive 2 hours to find a physician who takes Medicare.

As school started at UT for me Fall 2007, I quit my hellish job that had some health insurance benefits to go for a better work environment, better schedule and more money. I was hoping to get hired in in a couple months and get insurance working in the Chrysler Supplier Park. That didn't happen, by November, as a temp, I was let go and got lucky to start work at another plant next door in the same park. Hoping to get my days in before the big Chrysler cuts coming, I got a call on Christmas Eve to let me know I didn't need to show up for work until the middle of January with the big lay-off of the 3rd shift of the Nitro-Liberty line coming the 25th of January still.(This lay-off will affect my plant, affecting those on the bottom -me) I just had an interview at a company that has a great benefit package and I have a good feeling about this job.
I'm not complaining about the job climate in Toledo, it's just that I have not had health insurance, let alone a secure job in awhile. With that being said, I do not want a socialistic takeover of healthcare. Me and my wife have not been that sick. She did have to go to the dentist and I am on a payment plan that is awful. She has consistent migraines, and needs the doctor's visit. We pay for prescriptions out of pocket completely.

BUT, I know there is opportunity here in America that abounds like no other country. I know it's gonna be hard for awhile. I know it will take a lot of work. But as an American, I have the hope that if I put hard work into everything I do, I'll land a good job and one of the many benefits will be health insurance.

I don't want the rich to be robbed of a majority of their income because I am going to be up there one day. It won't be easy, but it will be worth it. I refuse to sit around and complain about everything that's "unfair," I'm gonna work my butt off until I get to the top.

So you are a minor accident away from having to declare bankruptcy and forcing a doctor/hospital to right off tens of thousands of dollars, which it will then in turn be passed along to the test of us.

so we should pass along my healthcare costs to you and the rest of the country before this accident happens?

Way cheaper now then later. Read GZ above...

Shouldn't this be more of a State's rights issue?

According to the 10th amendment, if something is not mentioned in the Constitution, the authority is delegated to the individual States. Where is health care mentioned in the Constitution?

... with that. A LOT of stuff should just be left to the "people or the States" as the US Constitution says explicitly. A right or responsibility doesn't HAVE to be specifically mentioned, as the document is designed.

... insurance actually does? It allows a pool of payers to carry the costs of their minority. What keeps such a system working is 3-fold:

1. Most if not all the payers don't want to assume the risks alone.
2. Most if not all the payers will try to avoid the circumstances they are insuring themselves against in the first place.
3. Participation is voluntary.

Thomas, why aren't you working to be middle class?

What happens to all the people who, statistically, cannot join you in the heights of your class no matter how hard they work? The rich can ONLY be a significant minority in the nation. We call them "heights" since they are be definition rarified.

I can tell from your posting that you're in no position to "get rich". You're working class and will continue to be subject to the whims of the Capitalists, who have plans for your job ... and those plans involve firing and blacklisting you, once you get to age 50. The Boomers are finding out that forced retirement at 50-55 is NOT working out ... obviously.

At any rate, the wealthy are no longer interested in being subject to the same taxation as the rest of us are. This is a flipflop from the 1950s and 1960s, when progressive taxation system went out of control. Neither extreme is fair.

Read some books by David Cay Johnson ("Perfectly Legal" and "Free Lunch"). The wealthy and/or corporate are getting away with the tax equivalent of murder.

First I think we need to define terms. What is the income range for the classes?

Secondly, "Thomas, why aren't you working to be middle class?"... "I can tell from your posting that you're in no position to "get rich". You're working class.."

Excuse me? Are my goals too high, you think? Your statements are borderline outrageous. You have no idea what I do or plan on doing in the future, but you think I should lower my goals. SCREW THAT!!!

FYI, I am a 22 yr old student who will have a law degree from UT soon. You're going to tell me to just work for middle class status since my posts sound like I'm working class whatever that is. The fact is, if I work and get good in whatever field I enter, via capitalism, I just might exceed your expectations.

"The wealthy and/or corporate are getting away with the tax equivalent of murder."

Did you know that corporate taxes are passed onto the consumers? So raising taxes on corporations will eventually raise prices on the consumers. In capitalism, the consumer tells the producer where to place the price of the good or service. How? The law of supply and demand. A corporation can charge 5 times as much as something is worth, but if nobody buys it, he makes no money.

And i have an author suggestion for you.... Ayn Rand's Capitalism the Unknown Ideal. I don't agree with her objectivist philosophy completely, but this is the best book I have ever read on capitalism.

... but you have NOT read Johnston. I already have that part of my education secured. Now YOU need to get away from the economic Darwinists like Rand and read what *I* recommended to you.

But even before that, you need to understand your own, unexamined biases.

You can't just consider income as some measure of economic class. When you see somebody with an income of $25K living in acceptable comfort, and somebody else with an income of $125K who has to bankrupt, you'll come to understand empirically why income is not a sufficient indicator. You also have to consider expenses, and then you have to consider the difference between income and expenses (either debt or wealth).

(Please note that debt is NOT wealth. If you think it is -- and many Americans do, which why they bankrupt so often -- then nothing I can say will make sense to you.)

A better indicator is the overall economic standing of a person; this takes into account income, expenses, and debt/wealth.

If you're lower class, then you cannot prosper from your labors, and in fact you can't even survive on your labors. Poor people often require charity in order to ensure their survival. There is essentially no chance of ever accumulating enough savings to ever make a difference, and debts are easily accumulated. Retirement is always chancy and often the poor fall to common diseases in their elderly condition and die either early or in true despondency.

If you're middle class, you survive nearly automatically, and seldom if ever require charity. Prosperity comes from your labors. However, you cannot stop working, since you don't have enough wealth that provides for the same level of income that provides survival, much less prosperity. With discipline, the middle class is in a good position to leverage income over expenses in order to create a base of wealth called "savings". With this base, a comfortable retirement can be secured.

If you're upper class, survival is never a concern, and prosperity is automatic. You don't have to work, since your income is derived from wealth. With a little discipline, you can transform wealth into enterprises, which either builds more wealth, or just steals it away from the commons (alas, the modern preference).

Now, Thomas, on that scale, where do YOU fall?

Considering your statements, you HAVE to work, but you don't seem like you're in need of charity to ensure your survival. That makes you the middle class ... and fairly definitely the working class (roughly composed of the upper parts of the lower class, and most parts of the middle class).

From my definitions, you can see there are interesting conclusions to make about the nation.

We don't have as many "poor" as is popularly advertised. A majority of the "poor" in the USA are actually low-order middle class. They tend to fall into problems of survival ONLY because they don't understand how to handle money. They also don't understand that DEBT IS NOT WEALTH. So, what opportunities they have, are largely wasted.

You can also see that a lot of people who are considered wealthy are merely middle class. Their debt loads ALONE dictate that. Hence, we have the example of the person earning $125K but needing to bankrupt from their inability to control expenses.

Now, Thomas, the rest of your false assumptions can wait, until we deal properly with each other's terms. If my assumptions about you or the classes are incorrect, then please correct them. Note well my definitions are NOT actually incorrect; it's just that most people misunderstand class and certainly don't understand finances (hence, witness the so-called "subprime crisis" the nation is in). That's why you blurted out about income as you did; like many Americans, you just don't understand what an economic class really is, since you don't understand that you can "spend yourself into the poorhouse".

It can take a life time to move up a class and only minutes to move down.

Well, GZ, you've outdone yourself, and I am impressed. That is an excellent summary and, should you decide to elaborate on it a little, could provide enough fuel for a warm discussion. I agree with what you've written, by the way, although you've neglected a few points - in the interest of brevity, I suspect.

Thomas, I suggest you aim for the upper middle class, which is a lot harder to attain than you might think. The rewards are proportional to the accomplishment, but I believe that you'll find that the climb to this lofty social strata will require the services of a Sherpa. If you wish to go higher than that, well, you're own your own. There are no Sherpas available this season. Next season isn't looking good either.

And now, GZ, the question that keeps me awake nights: How can anyone confuse wealth and debt? The two are as alike as a McDonald's McCheeseburger and last year's pencil sharpener.

Mad Jack
Mad Jack's Shack

So IF I become the best in my filed, where will I be in the class structure? Still in the middle? Technically, I could be in the upper class making 100,000 a yr, with a cheap house on the East Side and owning the right investments or properties. So let's tax the heck out of those thrifty individuals since the government isn't so thrifty.

Your disdain for capitalism is apparent and sad. Capitalism has raised more people than anything other economic system in the world. Even the Chinese Communists are getting this. Capitalism is what ended slavery and has never done anyone "wrong." Capitalism is a 2 way street which is completely voluntary. Freedom embodies the total concept. Lincoln did not see blacks as equals, but his hatred of free labor was apparent, and the harm free labor brings to capitalism is obvious. Capitalism won't happen when free-labor is in the mix.

I picture my journey through American economic class as a slow and generational process.

My wife and I grew up lower-middle-class. We always had a roof over our heads and warm food in our bellies (even if it was Mac and Cheese). We both qualified for reduced price lunches at school. Between scholarships and student loans, we were able to go to college. It took me 8 years to make it through for a BS and MS; it took my wife 6 years for her BS.

We now have good jobs with good marketable skills and find ourselves solid middle-middle-class. We're good savers (around $1200 per month pre/post tax) and live fairly modestly. We are however paying to send our kids to one of the best schools (public or private) in Northwest Ohio. We've learned that education as been the greatest factor in our climb up the economic scale.

We hope to elevate our kids into upper-middle-class. Even with all this work, we're still only an terrible accident or horrible disease away from loosing it all in a very short period.

The blogger entry by "January 7, 2008 - 4:03pm David Seaton" after the article is apt:

"I read what Donna Smith writes and it breaks my heart and makes me very angry. If Spain can have such a wonderful system, why can't the United States, that is much richer than Spain, have one too?

We all know why, don't we?

We are not one country.

We are two countries.

One of our countries is very large, struggling to get by and the other is very small, but very rich.

The rich don't really care if the poor die for lack of care and the poor are imbeciles if they think that rich people are going to write big checks to bankroll politicians that will tax the rich to provide medical care for the poor. To get that medical care the poor are going to have organize themselves and fight for it... dollar by dollar and vote by vote.

Any politician calling himself "progressive" and facing such a situation, who wants to "pour oil upon the waters", is nothing but a Judas goat.

What is fundamental is that working Americans develop a militant class consciousness. Rich Americans already have one.

If working Americans look up to rich Americans for solutions they will only get remedies that favor the rich. How deluded can people be, how alienated from reality can people be not to see something as obvious as this?"

Yes, I've really noticed that. Rich Americans live in a class-steeped environment. But we working class are demonized for ever mentioning "class".

On top of that, too many of the working class have their own form of class consciousness. It's called "being ashamed of being middle class". It's sick and it's wrong. You may as well be ashamed of the color of your skin or the base of your heritage.

Has anyone ever read "A Christmas Carol" by Dickens. When Tiny Tim's plight falls upon Scrooges ears does he say "If only we had a government controlled universal health care plan to help this poor child!" NO! He realizes his role as Bob Crachets employer to extend his profits to his employee. Health care is not a right, but a benefit. Isn't that what we work for fully provide for our families.
It is a waste of money to have the gov. control health care. Every social program the Fed or States control provides the least in benefits at the greatest cost with little choice.
We need a health care system which has competition, choice and portability. To ensure coverage for all it should come as an extension of our capitolism. My retirement, health care, unemployment, workers comp, disability, etc. all come from my employer. The gov. also provides funds for these reasons, but we should move away from that. It should all come from earnings and employers and allow each of us to have more choices and control over what we do. The gov. should only provide short term coverage for those unable to get it.
As for the health care itself. We have the greatest in the world. We simply need to keep it affordable and allow for all to have coverage. With the least amount of reliance of the Gov. The federal Gov has bigger fish to fry.

Companies are also moving away from providing benefits. We are becoming a service based economy and many service jobs don’t provide benefits to part time employees and they don’t hire full timers.

Private insurance is unattainable for you if have less then perfect health. I’d like to start my own company, but can’t because there is no way any insurance provider would provide my family with health care at any rate that an individual family could afford.

As an unemployed and uninsured person, I ask how does our current system does this, keep it affordable and available for all?

I cannot afford it, except if I get a plan that excludes every thing before the plan starts.

Jobs I apply for do not offer it.

I cannot qualify for fed assistance.

How is the system to be fixed when it is profit driven and not affordable of accessible by all.

Having the government is a no - no and the private sector is not responding to the crisis and people cannot afford and end up costing us all, as they use emergency services or do not pay for the services.

The answer to the problem seems to be that nobody knows and when a plan is set out it is shot down and back to the walking in circles we go and people go with out and our leadership is covered by some of the best in the land, so thier concern for the issue seems to be superficial at best.

i'm thankful we have health ins, but i have to work my butt off by calling them several times a month to get claims to go through correctly. it can take up to 5 reprocesses and me getting sent to a collection agency to get them to pay. i hate dealing with ins companies because of all the excuses they give me not to cover services. for example, they refused to pay for our son's open heart surgery when he was 10 days old because it was out of state, U of M was the closest hospital to perform the surgery, then they turned it down because they felt it was not medically necessary. it took me 6 months and being sent to a collection agency for $120,000 before they paid their portion.

on the other hand, my son qualified for BCMH (bureau for children with medical handicaps) for the first 3 months of his life because he was born with a heart defect. all children in ohio qualify for the first 3 months if they have a handicap, and after that it is based on income. we did not qualify after the first 3 months. they did not pay for anything either, so i had my private health ins AND BCMH refusing to pay. it's interesting because prior to my son being born i had never heard of BCMH, and they contacted me, but still did not pay for anything.

does anyone know of a site that really breaks down the presidential candidates health plans that is unbiased?

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