Talk:Healthcare in the United States/Archive 1

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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).

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)

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)

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. It is argued to be wasteful for the following reasons: 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)

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)

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).

Not sure what's going on with this, but in the "Mental Health Parity" subsection, an edit (which I did not clean up), struck through a reference to the Surgeon General and inserted an attribution to the Mormons, but the footnote references the Carter Center. This is not an area in which I claim any degree of expertise, which is why I didn't clean it up. I do know enough to realize that those are three entities whose interests might overlap at times, but only one can be the source of the statement in the article. Marstinson (talk) 13:51, 14 December 2008 (UTC)

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)

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. 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.--Jorfer 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)

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)

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.--Jorfer 20:48, 15 July 2007 (UTC)

Actually the consensus was for an unmerge so I went ahead and followed your Rotten's suggestion.--Jorfer 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)

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)

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)

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)

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 thosthan perse 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)

Carving out a particular section of the community for statistical pupose can be done in any country whether by racial or other deomgraphic definintions. It is disingenuous consideration as it implies "we" don't have that problem so it shouldn't be considered as important. In as far as subsidizing the truly lazy, I am with you completely but the difference between levels of success depend on more factors than personal effort. From the day an individual is born what determines their fate is a combination of both personal effort and luck and many of the "successful" are there by little personal effort as a consequence of their parents. Addtionally wealth does not necessarily correlate with what an individual puts into society. A Nurse may contribute far more than a successful car salesman, but the latter might earn many times that of the nurse The successful need rewarding, and that's what keeps innovation and progress and dreams alive, but the burden of cost falling more proportionatily on those who have benefitted most from the wealth creating machine can create a better society. Dainamo (talk) 11:45, 24 May 2009 (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)

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)

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)

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)

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)

If someone is an undocumented worker, is it certain they would appear in the number of uninsured in the population? Surely that would depend on how those figures are compiled? --81.150.229.68 (talk) 12:10, 15 July 2008 (UTC)

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)

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)

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)

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)

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)

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)

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)

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)

Congress

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

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)

Why dont america have universal health care

why cant the united stated of america provide health care for all of its citizen, its a shame to see that some many people there have to die just because their goverment did not seek to the needs of its citizen, but they can spend millons of dollors to support wars, an to fund programms that seek to destabilize other country like cuba just because some body will profit from it.......El thunder (talk) 18:12, 9 July 2008 (UTC)

Because Americans don't want universal heathcare. They DO want health insurance/coverage for everyone http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml

However, they don't want it to be run/managed by the govornment http://www.rasmussenreports.com/public_content/politics/issues2/articles/29_favor_national_health_insurance_overseen_by_federal_government.

You have to remember that the United States is a lot bigger than it's European counterparts. As a result, most federal action is incompetent and most Americans don't trust the federal govornment. http://www.politico.com/static/PPM41_publictrust.html Do you think Europeans want healthcare run by the European Union? Irish27612 (talk) 11:50, 15 March 2009 (UTC)

1. they do want universal health care ... just read the by-line ... health insurance for all IS universal health care!

2. its true that, for some reason, Americans do not trust their governments in the way the Europeans are inclined to do. Not sure why. Maybe its because people like you keep saying this. The VA health care program is Federally managed and is one of the most effective health care systems in the country. And Medicare as an insurer has very much lower overheads than the insurance companies. Probably because they don't try to avoid paying out for necessary care and leaving so-called insured people without health care.

3. UHC does not have to be a Federal program. Canadians have a Federal system of government but their UHC insurers are not managed at the Federal level. Come to that, neither are Germany's which also has a federal system of government. --Hauskalainen (talk) 23:17, 28 March 2009 (UTC)

But then you did not really have to create an account solely to tell us this. http://en.wikipedia.org/wiki/Special:Contributions/Irish27612 Looking forward to discovering your other interests Irish27612 and welcome to Wikipedia!--Hauskalainen (talk) 23:26, 28 March 2009 (UTC)

The reason that Americans don't trust the federal government is because it was specifically founded on not trusting the government. Jefferson and Madison, arguably the ideological founders of the country, made that quite clear. Then when you take into account that blacks were enslaved, Native Americans were brutalized, and the South was burned to the ground by the federal government, not that many people have a reason to trust it. Gtbob12 (talk) 15:03, 17 August 2009 (UTC)

Characterizing Criticism of WHO Statistics in the Lede

We've had some back-and-forth edits in the lede sentence discussing responses to the WHO rankings of health care systems. The original sentence was:

"The WHO study has been criticized by some for its methodology and lack of correlation with user satisfaction ratings."

and cited two sources: Why Isn't Government Health Care The Answer?, Free Market Cure, 16 July 2007 and Robert J. Blendon, Minah Kim and John M. Benson, "The Public Versus The World Health Organization On Health System Performance," Health Affairs, May/June 2001

This was changed to:

"The WHO study has been criticized by a pro free market group and some individuals for its methodology and lack of correlation with user satisfaction ratings."

The first source is by David Gratzer, a conservative critic of the Canadian system. The second was an article published in a peer reviewed health care journal by a professor of health policy and political analysis at the Harvard School of Public Health who is also a leading U.S. health care expert, a doctoral fellow in health policy at Harvard University and the managing director of the Harvard Opinion Research Program at the Harvard School of Public Health. This edit had the effect of suggesting that the criticism came from advocacy organizations and a couple of random nobodies.

I attempted to balance the characterization of the sources by changing the sentence to:

"The WHO study has been criticized by a pro free market group and in the peer-reviewed journal Health Affairs for its methodology and lack of correlation with user satisfaction ratings."

It's now been changed to:

"The WHO study has been criticized in an opinion piece published in the peer-reviewed journal Health Affairs for its methodology and lack of correlation with user satisfaction ratings."

This edit drops David Gratzer as non-notable, and has the effect of suggesting that the Health Affairs paper is nothing more than an editorial.

David Gratzer is a notable enough health care critic to have his own Wikipedia article. The Health Affairs article is in fact a cross-national comparison of public satisfaction with the health care systems, the WHO ratings, and an analysis of the correlation between the two. It does have the standard disclaimer "This work was supported in part by the Commonwealth Fund and the Robert Wood Johnson Foundation. The views expressed are solely those of the authors, and no official endorsement by either foundation is intended or should be inferred." This is typical for studies done with foundation sponsorship, and in no way should be taken to indicate that the paper is nothing but "opinion."

I would propose the language:

"The WHO study has been criticized by David Gratzer, a conservative critic of the Canadian health care system, and in the peer-reviewed journal Health Affairs for its methodology and lack of correlation with user satisfaction ratings."

This clearly identifies the source of the criticism and summarizes the basis for the criticism without taking a position on itEastTN (talk) 20:32, 6 January 2009 (UTC)

The OP is right. The article should not take a stance defending the World Health Organization. Make it NPOV. Knightskye (talk) 20:20, 6 May 2009 (UTC)

Blocking request for User:LincolnSt

Editors may wish to be aware that I have today placed a blocking request on User:LincolnStfor perisitently vilolating the spirit of editorial co-operation, for demonstrating bias in his edits, for depleting the usefulness of WP articles on health care to its readers and for making changes so rapidly that they seem to be planned aforethought and dumped on the editing community. See http://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/Incidents#Blocking_request__User:LincolnSt for examples and to express your thoughts if you have any. healthcare.--Hauskalainen (talk) 08:38, 29 January 2009 (UTC)

Hauskalainen, you haven't argued anything in the talk page. An editor associated with you, Cosmic Cowboy (talk · contribs), has already received the last warning from administrators.LincolnSt (talk) 11:57, 29 January 2009 (UTC)

Reference #1 DOES NOT EXIST

Do me a favor. Click the .xls (Excel) download file for Reference 1 and open it. Here's what it says:

"World Health Statistics 2008

Explanatory Notes

The responsibility for the interpretation and use of the material lies with the user.

The figures contained in this document correspond to the published version of the WHS 2008 and may differ from those posted on the database at www.who.int/whosis. Please refer to the website for updates.

Figures have been computed by WHO to ensure comparability; thus they are not necessarily the official statistics of Member States, which may use alternative rigorous methods.

For indicators with a reference period expressed as a range, figures refer to the latest available year in the range; except in Inequities in health care and health outcome, where the figures refer to the period specified. For specific years, indicator de

... Data not available or not applicable.

The global, regional and income aggregates for rates and ratios are weighted averages when relevant while for absolute numbers they are the sums. Certain Member States do not have an associated income group and are not included in aggregate calculations."

It's one page, and it does not provide the source for the "15% of GDP" figure used in the article. I've taken the liberty of replacing the reference tag with a "citation needed" tag. But I haven't deleted the Reference at the bottom. I hope someone can come up with an actual source for the statement. —Preceding unsigned comment added by Knightskye (talk • contribs) 20:17, 6 May 2009 (UTC)

Skewed Comparison with Canada and a question regarding the insurance of Chronic illness

Healthcare Discussin in USA understandably looks at its nearest neighbour Canada (which restricts private care to things like plastic surgery etc.) and there are objections by some who do not want univversal healthcare as the only means of providing for their needs. Without prejudice to its effectivelness, inthe UK private medical carfe and inusrnace exist for those who want non urgent care dealt with faster than the state NHS may provide it. The result is a higher level of care for all but an option to top up. The cost of insuran ce on the latter is much less as accidents aand emrgencies and a primary level of care are dealt with by the NHS. Example I have an NHS dcotor who deals with the basics and I needed to be referred to a consultant. I chose to use a private one on my medcial insurance getting the best of both worlds perhaps those that fear universal care most in the US do not relise this distinction?
The only thing my prviateinsurance does not cover is the ongoing treatment of chronic illness and I was wondering if this was the case with Insurances in the US. If I ever have a chronic illness, I know I will get a access to the NHS which is arguably far higher than that available on Medicaid. Since medioaid only provides where an individual has no resources do americans with chroinc illnesses face expencse that their indurances dso not cover thusw having to lose their savings etc. or is the insurance inlcusive of chronic conditions?
Another question that I would like cooments on relates to anecdotal observation that was made by a UK doctor I know that worked in the US. This concerned meeting the consumer demands for outcomes in the US sometimes compromised healthcare. The example something salong the lines of (excuse slight inaccuraracies aas I am not a medical person) was given of knee that needed some work (it involved some kind of platic insertion into the joint). The care provided in the US got the person walking within a week but the complaint would ultimately have to return six monthly. In the UK healcare system, the individual would have had the, intiially less desirable option, of being laid up for six to eight weeks weeks to allow proper healing, but the joint would have then been something permanent or, at worst, satisfactory for years to come. Unfortuantely the US doctor observed seemed more concerned with the immediate satisfaction of the patient who may not have realised there was an alternative, wished for a quick fix to get on with life or even the pressure of an insurer to reduce immediate costs (or whataever)instead of delivering the best clincial solution. Dainamo (talk) 12:26, 24 May 2009 (UTC)

User:Hauskalainen recent edit

In addition the government allows full tax shelter at the highest marginal rate to investors in Health Savings Accounts, which are mostly used by the wealthy as a tax shelter. Economists reckon that this subsidy adds little value to national health care as a whole because the most wealthy in society tend also to be the most healthy than those less well off and because there is little control over which medical expenses qualify for tax ememption, when these savings are spent it tends to be on non-essential care such as cosmetic dentisty and plastic surgery just to avoid paying tax.[Source: Verbal evidence of Robert Greenstein to 3rd Senate Finance Commitee Meeting on Healthcare Reform Financing, 2009] Also it is argued, HSAs segregrate the insurance pools into those for the wealthy and those for the less wealthy which thereby makes equivalent insurance cheaper for the rich and more expensive for the poor.[Source: http://finance.senate.gov/Testimony%20of%20Robert%20Greenstein.pdf LATEST ENROLLMENT DATA STILL FAIL TO DISPEL CONCERNS ABOUT HEALTH SAVINGS ACCOUNTS: The Center on Budget and Policy Priorities] Some argue that this is a waste of foregeone tax income that could have beem better directed.

First of all, this belongs in the discussion on Health savings account...not here. This article should include a summary of the health savings account article; it is inappropriate to have simply an argument against the current system presented here. Second the last statement is unsourced and even if it was it needs to be presented according to WP:NPOV. Third, the source (I say source because verbal testimony does not qualify as published naturally...see WP:V...there should be a transcript which you could use as a source) never states that it is mostly used as a tax shelter or that it add little value to national health care; the source simply expresses a concern that HSAs are disproportionally used by the wealthy since they are disproportionally advantageous to them. Fourth, one man does not equal economists. Fifth, it would need to be copyedited for grammar and spelling ("most healthy than those", "reckon", "ememption") but that is easily fixable.--Jorfer (talk) 00:40, 4 June 2009 (UTC)

OK. I agree with some of your points but not all. The ability to use a tax exemption to fund non-essential health care such as cosmetic surgery or cosmetic dentistry and the fact that the system tends to make health care cheaper for the wealthy and more expensive for those on moderate incomes does need to be in the article. I do not agree that we have to discuss these problems only in the HSA article. You can hear for yourself the evidence of Greenstein on the web at C-Span.org so we don't need a transcript. I have lost the link but it can be found again I am sure. I have been waiting for a transcript to appear on the Senate web pages but so far it hasn't happened. The implication of the testimony as I recall it was that this was a tax shelter that adds little value to the nation's health care and was an inappropriate outcome of the use of government concessions. Greenstein expressed this opinion and another economist at the table agreed with him. Instead of deleting the piece without much comment, it would have been more helpful if you had identified the problems in the text where you saw then with appropriate tagging. I am busy at the moment but maybe someone else will have the time to get the details to improve the text.

A tax break is not a subsidy. Any addition of the word subsidy to a tax break is commentary, not fact. Mrdthree (talk) 22:23, 19 June 2009 (UTC)

I think you are wrong. You should try arguing that at Talk:Subsidy. A subsidy reduces the cost to the payer and one way to do this is via a tax break. Maybe you are confusing the general term subsidy with the more specific term direct subsidy.--Hauskalainen (talk) 23:07, 19 June 2009 (UTC)

There are no citations in the subsidfy article it si all POV. If you can find a dictionary definition that includes tax breaks as 'subsidies' then you have an argument; otherwise you are merely arguing politics. A subsidy is a payment from government to an agent. I cannot understand how not haveing your money confiscated is a subsidy. Mrdthree (talk) 03:23, 20 June 2009 (UTC)

This is, frankly, mincing words. It seems to me to be that you argue from the old fashioned view, much favoured by some, that tax breaks are good (cos nobody likes paying tax) and subsidies are bad (because they distort the market). But the truth is that tax breaks are like subsidies and can distort the market. It matters very little if the government chooses not to tax you on your benefit in kind, or if alternatively eit taxes the income and then pays you a subsidy. The process is different but the effect is exactly the same. The tax break for employed persons receiving employer sponsored health care is at a distinct advantage over an unemployed person buying in the private market. His tax break IS a subsidy.--Hauskalainen (talk) 02:05, 22 June 2009 (UTC)

A subsidy is something the government gives to you. property is something you own. The government does not give anything to you (or a legal entity) when it fails to confiscation it from you (or a legal entity).Subsidy has a clear denotative meaning. By your definition all unequal taxation (and ownership) of property could be considered a subsidy of the government. THe claim that unequal taxation is a subsidy is political rhetoric; if you want to introduce political rhetoric, use a term that everyone recognizes such as corporate welfare. Mrdthree (talk) 14:44, 22 June 2009 (UTC)

Many people argue that a tax credit is effectively the same thing as a direct subsidy. I don't think there's any need to go into that debate here. Because we want to stay neutral, the safest course would seem to be for us to use terms that are as precise as possible - identify the particular tax advantage involved - and to avoid making any claims that are not explicitly made in the source. EastTN (talk) 16:59, 22 June 2009 (UTC)

I agree. The traditional view is that a subsidy is a direct payment, but economists will often use subsidy to indicate the opposite of a tax. By using "incentive" for a reduced tax rate and "deterrent" for an increased tax rate, we avoid that problem altogether.--Jorfer (talk) 17:46, 22 June 2009 (UTC)

New additions lack sources

This is part of what you want to keep:

Taxation policies also distort the market. The U.S. government for instance, unlike other some countries, does not treat employer funded health care benefits as a taxable benefit in kind to the employee. This foregone taxation effectively subsidizes employer-paid health care. Furthermore, the company offsets these cost against its own income; thus the company is less profitable and pays less in corporate taxes than it would if had not part funded its employees health care.

Read WP:V; there is a good reason for it. This argument is currently made from authority, not evidence. The first three statements are true but needs a citation. The last statement is not always true. The employer has an incentive to provide health insurance to its employees. It increases productivity, reduces time away from work, and reduces costs associated with turnover. If the health care system is cost efficient (which in America it is not), this will increase the profits of the company, and it will pay more in corporate taxes. I don't have time to go over the rest of your edits, but you need sources.--Jorfer (talk) 02:52, 17 June 2009 (UTC)

I am trying to figure out the which bits you are referring to

I assume you accept that

• taxation policies distort the market
• some other countries do tax the value of employee benefits in kind like health insurance
• the foregone tax effectively subsidized employer paid health care

but not necessarily that

• because employers contributions come before tax, the government receives less in corporate taxes

If you mean that companies would reduce prices and not pay more tax, well that may be true of course, but then the effect of that is that prices would be lower. That is very similar to there currently being a health care levy on goods and services (as I understand it, General Motors was in part brough down by this levy and MacDonalds pays out more each year in health care costs than it does on all the hamburgers it buys each year - or was it all the food, I can't remember now).

As for "there is very good reason for it", I would agree, if you mean that IT means the provision of health care is a good thing. But surely you are not arguing that "it is a good reason for distorting the market so that only employed persons get a tax subsidy and people buying in the individal market are not". Or are you? And as for whether emplyer provided health care is a good thing, it is a double edged sword as it is usually not portable when you leave your job. That is a HUGE disadvantage. As I recall Michael Moore is one person at least who has argued that it is a problem, because it means that people are forced to work in order to get health insurance. I've been following the recent congressional hearings and have heard real cases of people who are very very sick but who, having been forced to quit their job, have actually been forced to go back to low paying jobs with health care just in order to get the medications and treatments so that they can stay alive because buying in the private insurance market is so impossible for them. It is a kind of "uniquely American" (where have I heard that phrase before?) form of enslavement. In other capitalist countries, employed people have portable health care which they cannot be kicked out of. --Hauskalainen (talk) 08:53, 17 June 2009 (UTC)

Let's slow down here. "There is a good reason for it" comes after a semicolon, which means it is a value judgment of WP:V, and not the specifics of this discussion". I said "If the health care system is cost efficient (which in America it is not), this will increase the profits of the company, and it will pay more in corporate taxes.". I did not discuss my personal opinion on how good or bad the current system is. Wikipedia is not a soapbox on the health care system. It does not advocate a position, so if you that is what you want, there are plenty of other places on the internet to do that.--Jorfer (talk) 00:31, 18 June 2009 (UTC)

My edits are not hotly disputed. The only other editor to deal with them removed them as well. You state "As per Talk you accept that most of this is factually correct". This means you haven't read WP:V through; it states "The burden of evidence lies with the editor who adds or restores material" which means it is not on the editor who removes material. Regardless of the factual accuracy of the matter, according to WP:V "All quotations and any material challenged or likely to be challenged must be attributed to a reliable, published source using an inline citation."--Jorfer (talk) 00:44, 18 June 2009 (UTC)

(outdent) OK. I misunderstood what you meant by "there is a good reason for it". But the other points I make still hold true. Most editors, when they see something written they personally know to to be true few would go the extreme of deleting the text. Not every statement in WP is validated with a citation. Only those that are contested. Are you therefore contesting the validity of the 3 statements that you know to be true? I agree that WP is not a soapbox. It has to give honest and verifiable truth and where there are shades of opinion it must reflect that. I have copied below the text you have deleted. It would help me if you could bolden any statement that you think is plain incorrect (and in brackets say why) and italicize any statement that you personally doubt to be true and which therefore needs a reference. I will then oblige by doing what I can to address your issues.

Taxation policies also distort [alter is a better word to use here...distort carries the connotation of perversion and thus is not the most neutral word to use here] the market. The U.S. government for instance, unlike other some [some other] countries, does not treat employer funded health care benefits as a taxable benefit in kind to the employee. This foregone [unnecessary word] taxation effectively subsidizes employer-paid health care. Furthermore, [remove...tries to make a point] the company offsets these cost against its own income [revenue...if it is a business cost than it is offset before it makes it to income]; [repetitive...all this says is that the employer pays for the health insurance] thus the company is less profitable and pays less in corporate taxes than it would if had not part funded its employees health care. The value of the foregone [should be in present...this is not the past of forgo] tax revenue from a benefits in kind tax is an estimated $150 billion a year. Some regard this as being disadvantageous to people who have to buy insurance in the individual market which must be paid from income received after tax. [instead...this can increase the cost of insurance for those buying individually compared to an employer plan if it is being paid for with after-tax money] Some employers argue that insuring the health of their employees is a good thing and pays dividends because healthy employees are more productive, and some politicians therefore argued that encouraging this through the tax code must be a good thing. Others politicians believe that the tax code is distorting and the distortions could be removed if there was a personal mandate to be insured with a right to portablity [portability] of cover and no preconditions.

In addition the government allows full tax shelter at the highest marginal rate to investors in Health Savings Accounts. Some have argued that this subsidy adds little value to national health care as a whole because the most wealthy in society tend also to be the most healthy. Furthermore there is no control over which medical expenses qualify for tax exemption, which could be used to fund non-essential care such as cosmetic dentistry and plastic surgery. Also it has been argued, HSAs segregate the insurance pools into those for the wealthy and those for the less wealthy which thereby makes equivalent insurance cheaper for the rich and more expensive for the poor.

It doesn't say why it can be challenged. I can challenge it simply because it makes Wikipedia better and so can anyone else. A more appropriate guideline to reference in this case is actually the similar WP:RS. A big issue here, however, is WP:NPOV. I will add commentary.--Jorfer (talk) 03:05, 18 June 2009 (UTC)

Medical products research and development

What does this section have to do with the topic of the article? American Airline flies Boeing Aircraft but Boeing has no real significance in the delivery of airline services to the U.S. because American could just as well fly airplanes made by Airbus. Quantas flies Boeings too but that only tells us something of the success of Boeing and nothing siginificant about Quantas or the Australian Airline industry.

The Medical products industry is global and it is no doubt good for America that its medical products industry is innovative and leads the world. That however has little to do with the delivery of health care in the United States. Any technologies developed in the US can be marketed outside of the U.S. and be made available in Canada or France or almost anywhere with the money to buy it; The achievement of the US medical products industry is a an achievement of the Medical products industry and not the health care industry. The section is not relevant to the topic of this article. --Hauskalainen (talk) 22:47, 2 August 2009 (UTC)

The main point is its part of the debate because its part of the health care system. To me a huge part of the confusion in the debate comes about because people have no idea what the health care system is. Industry classifications give us an itemized definition of what the health care industry is. This definition includes pharmaceuticals, research and development (See http://en.wikipedia.org/wiki/Health_care#Healthcare_Industry). Mrdthree (talk) 23:46, 2 August 2009 (UTC)

You are confusing health CARE in the United States with the pharmaceutical and medical devices industry as defined by the stock market and claiming that others do likewise. Frankly, that is your own POV and one which I would strongly have to disagree with you on. Real people don't think like that. They know they get their health care from their doctors and nurses and not from GE or Glaxo Smith Kline (Glaxo was British by the way). As for the health care debate, none of the bills going thru the congress right now affect either the pharmaceutical industry or the medical devices industry. Its not about controlling R&D or pharmaceutical prices or anything like that. Why is this section connected to health care in the United States any more than it is connected to health care in any other country? It simply isn't. Its really irrelevant to the topic. --Hauskalainen (talk) 00:45, 3 August 2009 (UTC)

You are starting from an assumption of central planning of the economy. Health care is a private industry (mostly). This means that many independent actors come together to produce goods and services according to market demand. This is the system that exists-- a market system. If you are unfamiliar with teh components of a market system, please educate yourself. Go to Yahoo finance. Visit the industry classification websites. But remember the majority of health care goods and services are prodiced in a market system in teh U.S. As to teh specifics of pharmaceuticals, the Bush pharmaceutical bill will be revised. Also teh government is looking at price setting. Price setting is how the government intends to control costs. This means the government means to impact the revenues of private companies. Mrdthree (talk) 01:56, 3 August 2009 (UTC)

Being British, Hauskalainen, you might be unfamiliar with how private health care works. Health care in the United States is mostly private. Financing, planning and service provisions are determined by markets. The Global Industry Classification Standard and the Industry Classification Benchmark define the components of health care in the United States into two basic groups (1) health care equipment & services and (2) pharmaceuticals, biotechnology & life sciences. The particular sectors associated with these groups are: biotechnology, diagnostic substances, drug delivery, drug manufacturers, hospitals, medical equipment and instruments, diagnostic laboratories, nursing homes, providers of health care plans and home health care. Mrdthree (talk) 02:00, 3 August 2009 (UTC)

(Outdent). Please don't patronise me. The medical devices and pharmaceutical industries are private entities in europe too you know and of course they are classified by the stock market in that way too. As are private hospital groups. But YOU are missing the point TOTALLY. The point is the article is about health CARE and not the health INDUSTRY. Would you argue that because American Airlines uses Saudi fuel the source of the fuel is a factor in their airline Service? No! Its nonsense. Its a global industry. There are bits of it all over the globe and they sell their wares to anyone who can buy it. One national sector of one supplier industry has NOTHING of relevance to the delivery of SERVICE to a national sector of a different (but related industry). People don't say Bristol Squib Myers provides me with health care! I don't care what sector the stock market allocates to these companies, they per se do not provide my care, just as Boeing or AMOCO do not transport me across the Atlantic. They are enablers and they act globally and not locally. That is why it is irrelevant.

What do other editors think? --Hauskalainen (talk) 02:34, 3 August 2009 (UTC)

The industry classification has nothing to do with me. Please study industry classifications before making up straw man scenarios to complain about (Industry Classification Benchmark ). Pharmaceuticals are part of the health care system in the United States. Although you do raise a critical question-- how much of the economic health care data cited in this article includes pharamaceutical expenses? I am pretty sure it all does, but I dont know for certain. Is this a researchable issue? Mrdthree (talk) 03:27, 3 August 2009 (UTC)

I concur with Mrdthree's cogent analysis and disagree with Hauskalainen. It appears Hauskalainen has not visited the U.S. (or at least, not recently) and is unfamiliar with the extremely high levels of advertising in the U.S. media by private pharmaceutical, medical device, insurance, and hospital companies. American consumers are well-aware of the various levels of private entities that provide healthcare because of the huge amounts of advertising which they are bombarded with on a daily basis. Drugs and medical devices are routinely advertised in television prime time, billboards, magazines, and newspapers. This is all done to increase brand awareness so as to encourage patients to research and discuss specific options with their physicians. --Coolcaesar (talk) 09:59, 3 August 2009 (UTC)

I agree with Hausalainen. There are several issues with this section:

• It is incorrect to conflate a discussion of the pharmaceutical industry with healthcare in the US, especially since many/most pharmaceutical companies are not US-owned. This paragraph certainly does not belong in the lead.
• To say that profits from health insurance companies are directly responsible for the US's pharma/research output is WP:OR without a solid ref, and besdies that it's wrong for the most part anyway (check my background...).
• This paragraph appears almost word for word already in the '1.2 Medical products, research and development' section.
• The paragraph is not lead-worthy anyway - the whole lead paragraph needs serious revision and POV removal.

For these reasons I am reverting. Mjharrison (talk) 15:33, 15 August 2009 (UTC)

The fundamental problem with your position is that you are assuming you can separate the pharmaceutical costs from teh health care data on teh UNited States. I do not think you can. Pharma data is regularly included in peoples analysis of health care costs. I also would note that despite your great credentials to talk on this issue, it appear you have no direct knowledge of the UNisted States healthcare system and the relation of the pharma industry to it. For what it is worth I have a PhD in computational biology so make your case by analyzing the data and using research and citations rather than appealing to authority. Mrdthree (talk) 22:34, 15 August 2009 (UTC)

As all of the sources behind this paragraph are WP:SELFPUB except perhaps one which is behind a paywall, and in agreeing with the consensus that Medical products, and medical care are different things which should not be conflated here, I have removed the paragraph in the lead.Scientus (talk) 02:46, 25 August 2009 (UTC)

For those unfamiliar with the american system, when you go to a hospital in the United States you get several bills. The hospital bill is itemized and includes nursing services, pharmaceuticals, use of medical products, hospital facility charges, etc. The doctors and specialists tend to bill separately. These are jointly the health care costs americans pay and refer to. Mrdthree (talk) 12:47, 25 August 2009 (UTC)

WP:SELFPUB section says Self-published or questionable sources may be used as sources of information about themselves... . This is specialized information summarized about public companies by pharmceutical associations from Europe, not the United States. The information they report is not self-lauditory, it is self-critical. So I reverted the edit. Although I would like to get a mediator or administrators opinion on the general question of whether industry associations are a reliable source for information about an industry. So I posted the question on the Reliable Sources Noticeboard. WP:Reliable_sources/Noticeboard#Are_Industry_Associations_Reliable_Sources.3F Mrdthree (talk) 13:21, 25 August 2009 (UTC)

I've removed the paragraph from the lede. It's an argumentative passage based on industry self-advocacy. If it belongs anywhere, it belongs in the section on medical research. Also, independent reliable sources will be needed to support any claims of this general type. See also, WP:LEAD as a general guideline. For reference, here is the paragraph:

The revenues generated from these high healthcare costs have encouraged substantial investment: the United States dominates the biopharmaceutical field, accounting for three quarters of the world’s biotechnology revenues and spending in research and development. The U.S. produces more new pharmaceuticals, medical devices, and affiliated biotechnology than any other country, or the Western European nations combined.

... Kenosis (talk) 13:34, 25 August 2009 (UTC)

Without this paragraph, the lead is entirely negative in its facts and completely omits an industry perspective on health care--this is unintentional editorializing. There is a huge tendency in wikipedia to ignore financial and industry data. Healthcare R&D is the positive outcome of high costs. Introducing this fact balances the argumentative nature of the lead. However, I will bring other sources. Here are the relevant parts from the pay-wall article: "...Europe needs to keep on its toes. But it is investing much less than the United States, which is facing the same challenges. In 2004, the US non-industrial sector spent twice as much as Europe on biomedical research (around 0.40% of gross domestic product compared with 0.17% in the EU15—the 15 countries in the European Union before the accession of 10 candidate countries on 1 May 2004—a difference that would have been greater if all EU countries were included) and almost three times as much when adjusted for the size of the two populations...."Mrdthree (talk) 13:54, 25 August 2009 (UTC)

The point of the paragraph about reinvestment can very readily be stated in one brief sentence as an addendum to the statements about high cost, e.g.: "Industry advocates have stated that the relatively high cost of health care in the U.S. has encouraged substantial investment, and that the US is a world leader in biomedical research and development.[Cite to industry sources]" ... or some similar expression of the gist of the assertion. The rest of the specific arguments can quite readily be integrated into the existing section on medical products, research and development, while still allowing the crux of the argument to be retained in the lead. ... Kenosis (talk) 14:18, 25 August 2009 (UTC)

Sounds ok. I still want to see what is said about using industry associations as sources. Mrdthree (talk) 14:27, 25 August 2009 (UTC)

I've inserted the following sentence in place of the removed paragraph: "Industry advocates maintain that the high cost of health care in the U.S. has encouraged substantial reinvestment, and that the US is a world leader in biomedical research and development." ... Kenosis (talk) 15:10, 25 August 2009 (UTC)

The call at reliable sources seems to be that industry associations are reliable for financial data, so I would what to change the qualifier of "Industry advocates maintain" to something more definite, such as "Data compiled by industry advocates show that..." Mrdthree (talk) 03:12, 26 August 2009 (UTC)

The term "maintain" seems to me to be a pit POV. It seems, like the word "claim", to bias the reader. (Of course, I may be being too anal-retentive about it...) The Squicks (talk) 22:06, 26 August 2009 (UTC)