The Lancet’s being an unbiased and reputable journal here then, eh?

You can’t buy time – except, it seems, in America.

Increasing inequality means wealthy Americans can now expect to live up to 15 years longer than their poor counterparts, reports in the British medical journal the Lancet have found.

Researchers said these disparities appear to be worsened by the American health system itself, which relies on for-profit insurance companies, and is the most expensive in the world.

Their conclusion? Treat healthcare as a human right.

“Healthcare is not a commodity,” wrote US Senator Bernie Sanders in an opinion article introducing the issue of the journal, which is devoted to inequality in American healthcare. “The goal of a healthcare system should be to keep people well, not to make stockholders rich. The USA has the most expensive, bureaucratic, wasteful, and ineffective healthcare system in the world.”

Sanders, like authors of the lead report, called for single-payer health insurance or what Americans might know as “Medicare for all”, a reference to an existing public health program for older Americans.

An actual consideration of health care financing systems would be useful of course. But I doubt the Singapore system gets a look in, does it?

36 comments on “The Lancet’s being an unbiased and reputable journal here then, eh?

  1. It’s government regulation that has driven up the cost of healthcare and health insurance in the USA.

  2. Are they unhealthy because they’re poor? Or poor because they’re unhealthy? This is a question so rarely considered, let alone answered, by the likes of those who read Lancet.

  3. It’s a point I’ve been making for a decade now….sure, poverty causes ill health at times, but then so does ill health cause poverty at times.

  4. The Lancet has never been unbiased. It has always been a ‘campaigning’ journal, even from the days of Thomas Wakley (who ended up an MP). I don’t agree with its stance on many things and it comes across as an irritating, right-on medical student. That said, it has never claimed to be unbiased.

  5. Isn’t there a disparity in life expectancy in Britain between the poorest and the richest? And that’s with the benevolent hand of the NHS (PBUI) laying on Britain’s afflicted.

  6. So the cure for ill health is giving people unearned money?

    If so the trillions spent on handouts by the Yanks since 1965 should have given the USA the healthiest people and the least need of healthcare on Earth.

  7. “Increasing inequality means wealthy Americans can now expect to live up to 15 years longer than their poor counterparts, . . .
    Researchers said these disparities appear to be worsened by the American health system itself,. . . ”

    Yes, yes, far better to have a system where *everyone* lives 20 years less, then. At least we’d be equal, right?

    As one of those guys on near the lower rungs of the socio-economic ladder, let me just say fuck that noise. I’d rather live in a world where its at least possible to buy longevity – even if I couldn’t afford it – than to live in one where its not available at any price.

  8. Is there anywhere decent I can read up in a reasonably short and simple form about the Singapore system?

  9. https://en.wikipedia.org/wiki/Healthcare_in_Singapore

    To make it shorter and simpler. You pay a health care tax which goes into an individual account. That then pays for routine care (which includes things like hip replacements I think). Anything you don’t spend gets added to your pension pot. You as the individual thus keep a close eye on health care expenditure.

    But that’s for “routine” care. Get some ghastly cancer, horrible car smash, where you actually need the insurance part of it, where treatment is going to be far beyond individual ability to pay, government picks up the bill.

    That’s not in detail how it works but that’s how the economics works. Where prices and markets work they are not just allowed to work they insist upon it. Yes, most hospitals are government owned and run but they also compete on price, service and so on. They get the money from those savings accounts for the routine care. Where markets don’t so much work, catastrophic insurance, then the govt steps in through the tax system.

    Produces as good as if not better care than the NHS at under half the price.

  10. And in Singapore, when treatment is going to be far beyond individual ability to pay (or insurers’ viability) how does the government decide how much is enough and when to stop paying? Do they an equivalent of NICE, ‘death panels’ as they’re known in America

  11. You see, Singapore’s system probably qualifies as ‘socialised medicine’, exactly what flips the lid of a substantial section of the Republican.party.

  12. If healthcare (normally means medical care) is a right them someone has a duty to supply it. Only doctors and nurses are in a position to do this. Why then do we pay them for merely doing their duty?
    Of course if medical care is not a right, they are indeed free to charge.
    I know what I believe, but I wish the authorities could stop trying to have it both ways.

  13. “Isn’t there a disparity in life expectancy in Britain between the poorest and the richest? And that’s with the benevolent hand of the NHS (PBUI) laying on Britain’s afflicted.”

    Stopping smoking, cutting down on booze and eating a better diet will do far more for your life expectancy than changing your healthcare system. I’m not going to nanny anyone to do so, those are the facts.

    Most of that 15 years difference is smoking. Poor people smoke a lot more than rich people and die younger.

  14. As others have noted, if the US “for profit” model causes such disparities in death rates, then one would assume a ” or for profit” system like the NHS does not. Yet we are constantly assailed with stories like this about the UK. So that would imply the “profit” part is not the cause.

  15. @BiW

    “Stopping smoking, cutting down on booze and eating a better diet will do far more for your life expectancy than changing your healthcare system. ”

    Nah- your life won’t be longer, you’ll just feel like it is.

    Seriously- this thinking (that a healthcare system is a meaningful impact on your individual life expectancy) is bananas.

    The politicians love it ‘vote for me and you’ll live longer!’, but it’s damning of us as a society that we’ve allowed health to become so politicised

  16. “‘socialised medicine’, exactly what flips the lid of a substantial section of the Republican party”: given the certain scale of incompetence and corruption that would attend an NHS run by the US federal govt, the Repubs have a case.

    It was Megan McArdle who introduced me to the argument that one reason why West Europeans tolerate bigger govt is that their governments are typically more competent and less corrupt than Uncle Sam.

  17. Tim Newman,

    “Are they unhealthy because they’re poor? Or poor because they’re unhealthy? ”

    I think the two things are somewhat connected. There are people out there who like being lazy and enjoying themselves a lot. It’s like a single attitude thing but it affects both health and wealth.

    I know a guy who tried to be a software consultant and just couldn’t cut it and part of his problem is that he just didn’t care enough about work. I once threw an interview his way. Next day, start monday. He was out of work and was like “oh, but I’m going to a beer festival tomorrow, so I’ll have to skip that”. I mean, I’d get it if he was turning down an interview because Anna Kendrick was coming round for a nooner, but a bunch of beardies talking about hops?

  18. “The goal of a healthcare system should be to keep people well”.

    Really, Bernie? You think individuals have no personal responsibility to look after their own health? You think a “healthcare system” should be responsible for “keeping people” from behaviors that government bureaucrats determine will make you unwell? There’s a whole lot of denial going on in that view. (To be fair, denial of reality is perfectly consistent with most of Bernie’s views).

    Besides, doesn’t being “well” usually mean that one’s diagnostic workup is not yet complete?

  19. Ironman

    http://assets.ce.columbia.edu/pdf/actu/actu-singapore.pdf

    “Although Singapore’s healthcare system is comparatively more efficient than many other countries , it still faces some problems. At first , feedbacks gathered by CPF board illustrate the insufficient coverage for post-retirement health care expenses. It is the scenario particularly for the elderly above 85 years to whom Medishield provides no coverage. Once the savings are fully utilized, those members most in need of catastrophic healthcare have few financing sources to resort to.”

    Old people are stuffed.

  20. And in Singapore, from where I write this, they don’t pay for immigrants’ healthcare AT ALL until you become a permenant resident and start paying into the CPF. Maybe some other nation that I flew from last night could do the same? Easily done here. No ID no treatment.

  21. The Lancet article (here) is about how the US healthcare system fails poor people. Why on earth would it talk about Singapore?

    Isn’t it obvious to everyone but the Republican Party that you can’t have first-world healthcare paid for by voluntary individual insurance? The young, rich and healthy have to subsidize the old, poor and sick, or else the old, poor and sick will go without.

    That doesn’t mean you have to have an NHS, or even a single-payer system. The US might look to Germany for a workable solution. That is, it might if its governing party weren’t insane.

    (The Singapore approach, of having 40% of your labour provided by non-permanent immigrants, is not available to the USA. Especially after they’ve built The Wall.)

  22. “Isn’t it obvious to everyone but the Republican Party that you can’t have first-world healthcare paid for by voluntary individual insurance? The young, rich and healthy have to subsidize the old, poor and sick, or else the old, poor and sick will go without.”

    Go without what? You falsely equate insurance to health care.

    Pat – “If healthcare (normally means medical care) is a right them someone has a duty to supply it.”

    People’s rights end where other people’s rights begin. No person can have a right to someone else’s goods and services. So people like Crazy Bernie are either stupid, or don’t actually believe in human rights, but are happy to speak of “human rights” as a means to eliminate human rights.

  23. Andrew again:

    “And in Singapore, from where I write this, they don’t pay for immigrants’ healthcare AT ALL until you become a permenant resident and start paying into the CPF. ”

    I think Schengen Convention nations still require that applicants for an entry visa must present proof of adequate medical insurance as a condition of issuing the visa.

  24. Go without what?

    Healthcare, obviously.

    You falsely equate insurance to health care.

    No I don’t. Someone has to pay, whether for insurance or for healthcare directly. If no one pays, they go without.

  25. Singapore had a massive baby boom in the fifties and sixties. It now has one of the lowest birth rates in the world. The result is that, for the time being, a very high proportion of its citizens are of working age. Additionally, it has a very large “non-resident” labour population.

    Healthcare spending is disproportionately on old people, and on maternity and newborns. It’s not surprising therefore that Singapore manages for now to have low healthcare costs as a proportion of GDP. This will change a lot over the next twenty years. (The government is aware of the problem, and proposed to address it by increasing still further the non-resident workforce, but that’s unpopular.)

    Pointing at Singapore as an example of how the rest of the world should run healthcare is daft.

  26. This blog is not a happy place to admit it, but Social Justice Warrior is saying it as it is. The costs of providing a medical response to catastrophic or.life-changing or long-term conditions just don’t get met by private insurance and never can be. The only payer in the fame is government. No,that dodsn-t mean an NHS -stupid idea – but it does mean “socialised medicine”.

  27. Social Justice Warrior, and I am Loth to admit it,is on the money here. Singapore’s system is facing acute crisis in the next three decades.

    However, what happens when there are not enough young people being born because of a variety of factors (public support/funding for alternative sexuality, abortion on demand, a cultural shift in women’s expectation?) and an ageing population? Where dies the money come from, in any system, whether single payer or private insurance?

  28. Social Justice Warrior – “The Lancet article (here) is about how the US healthcare system fails poor people. Why on earth would it talk about Singapore?”

    Because there is a model that is cheaper than the model they want, that provides excellent outcomes, but that is not ideologically sympathetic to their goals – so they ignore it. That goes to their honesty and integrity. As in they have none.

    “Isn’t it obvious to everyone but the Republican Party that you can’t have first-world healthcare paid for by voluntary individual insurance?”

    No it isn’t. Health costs something. It must be taken out of what would otherwise be saved or consumed. There is no reason to think that sending it to the government is a better way of doing it than any other. After all, health care should not be a great part of the economy. Singapore is down at 4-5% or so. In other words, it is much less than food. Yet oddly we do not have a National Food Service that makes sure everyone gets enough to eat.

    “The young, rich and healthy have to subsidize the old, poor and sick, or else the old, poor and sick will go without.”

    That does not follow. Insurance is a gamble that you will get sick. People should buy insurance. It doesn’t matter what the final spending actually is – only that the actuaries have done their sums right. Again there is no reason to think that taking money out of present consumption by means of the government is superior to doing so by any other means.

  29. Ironman – “The costs of providing a medical response to catastrophic or.life-changing or long-term conditions just don’t get met by private insurance and never can be. The only payer in the fame is government.”

    Nonsense. Suppose everyone contributed 17% of GDP to private insurance. Why wouldn’t that be enough to cover any and all catastrophic, life-changing or long-term conditions?

    The point is to allow insurance companies to charge accordingly – and allow life-time rates as opposed to allowing people to sign up today once they know they have cancer.

    There is no superiority in allowing the government to take our money and then hand it out to their friends as opposed to letting us spend as we like.

  30. Ironman – “Just stick to talking about race mate.”

    Because you can’t handle anything more complicated? Well do try to keep up.

  31. “The costs of providing a medical response to catastrophic or.life-changing or long-term conditions just don’t get met by private insurance and never can be.”

    Absolutely backwards.

    That’s all insurance should be.

    We have perverted “insurance” into third-party payer, the root of the problem. Medical insurance should have very high deductibles, paying for nothing but the “catastrophic or.life-changing or long-term conditions.”

    Otherwise, it is NOT insurance.

  32. SMFS seems to suggest that healthcare in the US could be paid for by some sort of lifelong insurance contract.

    Just pretending for the moment that that’s workable in principle, how much would it cost? US healthcare spending is about $10k per capita per year. So if you work for 45 years and live for 80, the annual cost to spread over your working life would be about $18k. The median income in the US is about $30k.

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