1961

But you suggested that it was clear that outcomes and efficiency of public systems were superior to the US, but that isn’t true. That’s not what these source are saying.

Don’t get me wrong, universality of coverage is important, but that’s not necessarily the same thing as patient outcomes and satisfaction.

It’s fine to state the advantages of systems, but not too extend them into areas where they clearly demonstrated.

1962

Same or similar outcomes for cheaper = superior for most people.

1963

As soapyfrog says. Similar to better outcomes at a fraction of the cost means means a much more efficient system.

Again, patient satisfaction is only relevant in a private system where patients can go to the competition. The relevant metric is outcomes. Moreover, one of the big causes of overexpending in the USA’s system (and some studies say also it might be the reason for slightly worse outcomes) is over testing/over treatment, which is closely related to the need of the system to provide a higher patient satisfaction (hurting efficiency and outcomes in the process).

Edit: Honestly, this is all pretty much the view of the scientific/medical research community. You normally are good at looking at the data and avoiding misconceptions. Public systems in high income countries are vastly superior in efficiency and moderately superior on outcomes (more superior the lower the social stratus of the patients, with equal or slightly better outcomes at the top socioeconomic layer). Maybe patient satisfaction in itself justifies doubling or tripling (at least) the costs, but given that you are concerned costs are skyrocketing, then maybe we should stop looking at subjective measures and keep the objective ones.

As others, I don’t think public management is inherently better in non-fundamental fields, and it’s prone to its own sorts of corruption. But in healthcare, that’s what the data seems to be saying.

1964

Again, patient satisfaction is only relevant in a private system where patients can go to the competition.

No, that’s not really true.
Patient satisfaction still exists, even in systems which don’t let you actually do anything as a consumer. And it reflects more than simply outcomes, because it can encapsulate things like waiting for service.

Also, it’s worth noting that even your own sources don’t actually support the simplistic statement state outcomes are the same or better. It’s more complex than that. There were lower mortality rates than Europe for prostate, breast and colorectal cancers, and a higher mortality rate for lung cancer. The chances of you being one of those three is higher than the chance of getting lung cancer. And this is only one tiny facet of the overall system.

Again, I’ve already stated that given the inability for a market to effectively work in this type of commodity, I support government involvement. I just don’t believe that the suggestion that public systems actually improved service is supported by evidence. (Beyond the inherent improvement stemming from increased access)

1965

Read the link I provided (hint, no the one about different cancer outcomes). It’s a meta study from an American institution doing a holistic assessment of the issue looking at many different studies. The conclusion is the the healthcare gap exists, and its not limited to (but more prominent in) the lower income segments of the population. That is, outcomes in general. While some particular outcomes are better in the US (mortality over 75 years old, for example) in average a poorer performance is shown.

Causes for this are considered to be systemic. On one side better coverage benefits those covered. On the other side, private systems that value client satisfaction tend to overtreat and overtest (because that’s what the patients want to get tested and treated for anything found), which actually lowers quality of life and life expectancy in general (those extra treatments have long term consequences in many cases, and are mostly unneeded). that is, there’s evidence that points towards the behavior of market forces actually harming the patients (because that’s what they want, but they don’t see the harm and instead they get client satisfaction).

Moreover, consider this. If client satisfaction is so much higher in the US, why the critique and perceived need to change the health care system is also much higher in the US?.

Since what they compare against is mainly countries with universal healthcare (because that’s what every other country at a similar economic level of the US has), it means public systems had better performance than private. The fact of them being public might not be the cause (although the study strongly implies so), but the correlation (and the fact) remains.

Adit: another article for you : http://www.urban.org/sites/default/files/alfresco/publication-pdfs/411947-How-Does-the-Quality-of-U-S-Health-Care-Compare-Internationally-.PDF

While the evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S. health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional.

Like other countries, the United States has been found to have both strengths and weaknesses in terms of the quality of care available, and the quality of care the population receives. The main ways in which the United States differs from other developed countries are in the very high costs of its health care and the share of its population that is uninsured.

1966

There are better ways of making this comparison, Timex, because one “higher” does not cancel out one “lower”. You need to consider the magnitude of each effect.

The article itself makes the appropriate comparison:

Compared to Western Europe, for three of the four costliest U.S. cancers—breast, colorectal, and prostate—there were approximately 67,000, 265,000, and 60,000 averted U.S. deaths, respectively, and for lung cancer there were roughly 1,120,000 excess deaths in the study period. … The excess U.S. deaths from lung cancer swamp its lower mortality rates from breast, colorectal and prostate cancer. If you add together the figures for all four cancers, the U.S. had 729,000 excess deaths

1967

In defense of Timex, I didn’t like that article too much. Looking specifically at cancer, real survival rates are extremely similar along all developed countries, but differences in the epidemiology in each country can throw numbers off track. Without full access to the original article I would be very wary of those conclusions.

As an example, melanoma has incredibly high survival rates in the US versus Western Europe (90% vs 30% I think, quoting the numbers from memory). But that’s because there’s also a much, much higher incidence of the illness in the US, in the shape of extra cases of superficial melanoma that have much better prognosis that usual cases. The US gets it’s (similar) share of non-superficial melanoma too. If you adjust for this extra incidence and look only at similar cases, survival rates suddenly pretty much even out.

It could be the case, for example, that US lifestyle choices or working conditions (or environment) cause more severe/harder to treat cases of lung cancer, thus the higher mortality, without it maybe saying anything about the efficacy of the treatments/system. Also, are they looking at mortality in the overall population (influenced by incidence) or mortality of diagnosed patients? It’s not very informative overall.

But you are right in that the only way to look at this is to take the overall picture, since looking at specific illnesses/conditions might not account for factors not controllable by healthcare. By looking at more overall outcomes you can even out those factors as much as possible.

1968

No dude, that isn’t an effective comparison either. It’s just as arbitrary.
You can’t boil down an evaluation of the healthcare system into a mortality rate of one disease.

1969

Well dude, you’re the one that decided to make an example out of cancer a few posts back.

Regardless, the point of the article was to compare differences in life-years saved to spending. And you can certainly do that within a single disease entity. In fact, that’s the only logical way to determine whether it’s worth spending $x on a particular treatment.

In cancer treatment, the US does worse according to life-years saved AND it does worse in money saved. That means we are doing something wrong when it comes to cancer treatment, which is a significant part of our total health care spending.

I don’t think there are substantially different cancer exposure risks between Western countries, with the exception of smoking (which actually favors the US).

If cancer is harder to treat in the US, it’s because it is detected at a later stage. And that’s the fault of the health care system.

1970

The same or similar, at a fraction of the cost. Some things better, some things worse, mostly pretty comparable.

If cost = better outcomes, imagine a public system where they spent as much per capita as the US… we’d all live to 150 ;) anyway point being just throwing crazy money at it does not necessarily improve outcomes, and in this case the private system appears to be very much less efficient, and with less coverage of the population.

1971

It’s hilarious that you quoted a phrase of a sentence.

1972

I apologize for zeroing in on the crux of the matter and discarding all the chaff and smokescreen.

1973

Yes, it is clear that is what you did. Well done.

1974

Nah, we mostly agree in the important stuff, but there are differences in epidemiology between countries. Whether those are because differences in exposure or in genetics it’s something that doesn’t seem 100% clear yet. But definitely there are very different incidences in certain type of cancers depending on the country.

Now, as you say, if we look at the overall number (for example looking at all cancers), things become much less muddled.

1975

Hah, this is hilarious:

http://www.wsj.com/articles/notable-quotable-a-feminist-glaciology-1457478031

From “Glaciers, gender, and science: A feminist glaciology framework for global environmental change research,” a paper by researchers at the University of Oregon, underwritten by the U.S. National Science Foundation, in the journal Progress in Human Geography, Jan. 10:

Ice is not just ice. The dominant way Western societies understand it through the science of glaciology is not a neutral representation of nature. The feminist glaciology framework draws attention to those who dominate and frame the production of glaciological knowledge, the gendered discourses of science and knowledge, and the ways in which colonial, military, and geopolitical domination co-constitute glaciological knowledge. Even in a globalized age where the place of women and indigenous people has improved markedly in some parts of the world, masculinist discourses continue to dominate, in subtle and determinative ways. Feminist glaciology advocates for a shift of preoccupations in research, policy, and public perceptions from the physical and seemingly natural, to a broader consideration of ‘cryoscapes’, the human, and the insights and potentials of alternative ice narratives and folk glaciologies.

The critique and framework outlined here illuminate experiences and narratives that emerged historically but remain potent today. Public discourse on the cryosphere continues to privilege, quite explicitly, manly endeavours and adventures in the field, and those who conduct their science in the manner of masculinist glaciologists and other field scientists of decades and centuries past. . . .

The call for a feminist glaciology is not limited to ice and glaciers, but is a larger intervention into global environmental change (and especially climate change) research and policy.

I’d think it was more funny if the paper had not been underwritten by my tax dollars and the National Science Foundation.

1976

Well, the paper sounds funny because the introduction is filled with jargon while simultaneously trying to be provocative. But that’s unfortunately a pretty common feature in academic writing these days, as writers are encouraged to apply marketing techniques to technical writing. Basically, it’s the TEDification of academia. You noticed this one only because of the feminist buzzwords.

Digging further into the text, the facade falls down and the paper evolves into a typical discussion of improving women’s participation in geology. For instance,

One way to diversify knowledge production and collect environmental knowledge from local women is through emerging methodologies, such as locally-led indigenous ethnographic video (audio-visual storytelling) among women in the Pamir Mountains of Tajikistan (Williams and Golovnev, 2015). This project’s goal was to examine how local indigenous assessments of climate change and glacier shrinkage corresponded with scientific, governmental, and NGO conclusions. Team leaders specifically sought women’s voices and contributions after recognizing that women generally did not hold public positions of authority. Ultimately the video production process not only involved local women in three communities, but also went beyond participation to achieve active collaboration in both the video creation and the collection of climate- and glacier-related knowledge. Knowledge about changing climatic conditions and glaciers varied among the women involved, with one participant appreciating the warmer weather at high elevation, another lamenting the loss of a glacial lake for its hydrologic impacts, and another who inhabited an urban area being largely unfamiliar with nearby environmental changes.

Maybe not your cup of tea, but not exactly useless given the widely acknowledged problem of insufficient women in STEM.

1977

Oh, check out Luce Irigarays writings on physics. E=mc2 is a sexed equation as speed is masculine etc. From the 70s no less, this isn’t new.

Perhaps the gender studies wastrels encourage women to go the STEM route by publishing nonsense dressed up with jargon filled waffle and gobbledygook and putting people off gender studies. It is a plan I guess.

Edit: and actually, they are saying that glaciers shouldn’t be studied with Eurocentric patriarchal concepts like satellite imagery and ice measurements, but they should abandon the masculine scientific approach and analyse how glaciers feel. Magnet laps this shit up like a dog with a mineral deficiency, I look forward to more earnest defences of folk science as a replacement for um… Science. Post modernist thinking at its finest.

1978

Btw, missing a few tricks here folks. JK Rowling is in the middle of culturally appropriating Native American mythology for the new Potter books and the chatterati are in a collective meltdown. I think her best bet is to write the skinwalkers as black and gay and play off the different factions.

1979

The only reference to aerial or satellite imagery is found in the final section, a detour into discussing glacier art.

Whether it’s nicer to draw glaciers from close-up or far away is completely irrelevant to the science.

{Citation needed}

While I’m sure it’s amusing to attribute all sorts of strange goals to the authors, the boring truth is spelled out right in the article:

The goal is neither to force glaciologists to believe that glaciers listen nor to make indigenous peoples put their full faith in scientists’ mathematical equations and computer-generated models (devoid of meaning, spirituality, and reciprocal human-nature relationships). Rather, the goal is to understand that environmental knowledge is always based in systems of power discrepancies and unequal social relations, and overcoming these disparities requires accepting that multiple knowledges exist and are valid within their own contexts.

So, it’s yet another entry in a long list of critiques regarding the objectivity of field sciences.

1980

More mythology.

Same complaint the communists had; foreign agents-provocateurs and saboteurs infiltrated the communist system and tried to break it. Isn’t that interesting!

The false equivalence tic is strong with this one. You are comparing the documented takeover by Marxists of both the general socialist and the labour union movements from the end of the 19th century through to the beginning of the 20th, with lies and propaganda spewed by totalitarians to excuse the failures of their regime. Well done, you’re on the right side of history again! ;)

More conspiracy silliness. It’s all about brainwashing again with you. It couldn’t be that given the largest percentage of the population a good base education improves social mobility and increases the number of brilliant minds who can spring forth from bad circumstances!

Err, the point of what I was saying was that the “base education” isn’t very good, and it’s gradually gotten worse.

You just can’t help yourself can you? I keep telling you we’re on the same side with regard to goals, but you refuse to believe that anyone else can reasonably believe that the means you favour aren’t getting us to the goals. So since I’m suspicious of your means, I must be after a different goal, and you’ll do your damndest to try and winkle out my true intentions as being opposite from yours. Outstanding, my dear heresy hunter, truly outstanding.

The truth is that universal education results in greater engagement of the population in all aspects of society.

As I’ve been trying to show, it looks like there was already something approaching universal education being provided privately (in all sorts of ways) before the government stepped in to provide “universal education”. There was certainly a principled, liberal argument for the state plugging in the gaps, but there was never a principled, liberal argument for the state being the universal education provider. That argument came from the Right, and the Left fell for it - partly for what one might call the hubris of Jesuitical reasons (“give me a child …”, etc.).

The result of “universal education” provision that is crap, is that we are descending into an Idiocracy - a far cry from the informed citizenry we both desire.

Again, you are completely bamboozled by the house mythology.

Perfectly good medical care with outcomes as good as and in some cases better than that offered by the American system, and at a fraction of the cost.

You must be a fan of Michael Moore.

Already the case that the state can take children away from their parents if their parents are not feeding them.

Yes, but the state doesn’t take upon itself the burden of universal food provision for children, does it? Yet according to your “reasoning”, it ought to, right?

Yes the state should make sure that everyone has access to clean water and that people do not starve. No one in the 1st world should ever starve.

Naturally. And I’ve already gone over how “gap plugging” is and has always been a reasonable, principled, classical liberal position. “Universal provision” by the state of anything is not (except in a few cases of public goods and market failure).

And you conveniently ignore the fact that you could equally be a victim of a “mind virus…” if you really beleive that is how human cognition works then you cannot discount that. Therefore you cannot trust yourself or be responsible for your words or actions.

It’s like arguing if free will exists or not. There is not actual scientific evidence that free will exists, yet taking the position that it doesn’t is not tenable for society.

More false equivalence. Clue: the very fact that I’m arguing should be evidence that I don’t think the situation is unsalvageable. We are all prone to cognitive bias, but there’s nothing inevitable about it.

The situation is like this: our minds are an ecology of memes (replicable patterns of human action), some of them good, some bad (under any given definition of good/bad). If your aim is (broadly speaking) human flourishing, then the memes we reproduce amongst ourselves fall out as good/bad in relation to that. The proposition is that religious and ideological memes are bad; the good ones, the ones that guard us against religion and ideology, are the cluster of memes around reason, logic, evidence-based argument (also moral courage - e.g. not being afraid to lose friends for saying something that goes against your “tribe”'s views), etc. If you find this description more or less reasonable, then you should understand that there’s no reason for you to make toy false equivalences between me and ideologues, because we’re all in the same boat.

Re. free will. As a quick and dirty response, I’ll say I side with Daniel Dennett’s compatibilist (sort of) response against Sam Harris in their fairly recent exchange on the topic. The “philosophical” notion of free-will was always bogus, always a profound philosophical error, but there is a sense of the concept of “free will” as it’s used in ordinary language (without the philosophical baggage) that’s absolutely functional and viable even in a deterministic universe and it’s not necessary to get rid of it (in fact it would be positively detrimental to try and get rid of it).