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Medical Care Gets Outsourced Too
Muppy writes "Here's the summary from the most emailed article in The Washington Post today -- about an American who went to India for heart surgery, which he could never have afforded here. U.S.: $200,000 total cost ($50,000 deposit required) for heart operation. India: $10,000 total bill, including hospital, air fare, and a side trip to the Taj Mahal. And the Indian doctors are probably at least as good as those one is likely to get in the U.S. From the article: 'Eager to cash in on the trend, posh private hospitals are beginning to offer services tailored for foreign patients, such as airport pickups, Internet-equipped private rooms and package deals that combine, for example, tummy-tuck surgery with several nights in a maharajah's palace...'"
£0, but some serious taxes and a wait on a waiting list.
Even so, I must say I prefer universal healthcare.
Gamers Europe - Gaming News. Reviews.
Something economically is going very wrong in our medical system when everywhere else in the world is getting the same goods and services we are for much less...
Remember, perscription medications are very much an IP-based business. The first pill costs millions in research and approvals. Once the pill is ready for mass production, the actual ingredients cost very little to gather and put together. That's the reason why there has to be patents on medications... without that IP-based protection, nobody would pay to do the research that creates new drugs.
Still, when Canada's getting the medications for less than they're being sold in the USA... something's very wrong. It feels like every other first world country has set price controls that the drug makers are bowing to, and because we don't have price limits, they charge us to make the money.
It's an interesting dilema... if we pull out of funding the world's research, that research just isn't going to get done. On the other hand, we're funding the research that the rest of the world is benefiting from and not paying for.
I don't understand all of this "outsourcing" outrage. Doesn't India "outsource" manufacturing of soft drinks to American Coca Cola and Pepsico? Isn't it just progress, that anyone can do what one can do best, no matter where one lives? Why discriminate against people of any given nationality instead of cooperating globally? This is a perfect example. Why should people not be able to get the best medical care only because it is not available in their homeland?
Sincerely,
Pan Tarhei Hosé, PhD.
"Homo sum et cogito ergo odi profanum vulgus et libido."
The USA already outspends Germany and Japan per student. The problem isn't that we spend too little, it's that the money gets pissed away on administrative costs instead of compensating teachers adequately. Add to that the NEA's tooth-and-nail resistance to anything resembling competition or accountability, and you get the mess that is American primary education today.
-jcr
The only title of honor that a tyrant can grant is "Enemy of the State."
American medical care is expensive because of artificial supply constraints at every step. When I went through pre-med in college, anyone could tell you that the process is designed to "weed out" the pool of potential doctors; that phrase is the mantra in every course. The weeds are people without sufficient profit motive to survive the often arbitrary, abusive process. That includes foreign doctors who move to the US for freedom, but without the financial or competitive advantages needed to get recertified. That limited supply of doctors, including less competent ("malpractitioners") in medicine, but committed to their paying careers, means extra demand for doctors for second/third/etc opinions, fixing mistakes, medical makework... If America invested more in educating doctors, the supply/demand crisis would be calmed at both ends, and medical treatment would cost less. Then we'd just have to worry about unnecessary prescriptions, pharmacy profits, insurance profits, and career malpractice fraud lawyers.
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That's what all the media tells me: Canada's healthcare is falling apart! Canadians pay more! Canadians have hoooje waiting lists! The sky is falling!
Pah.
Canada may not have perfect healthcare, but we sure as hell aren't (a) paying for heart surgery; and (b) taking off to India to get it.
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The school district here, decided that it was a good idea to spend several million dollars for football field upgrades. Until we decide that education has a higher importance in our EDUCATIONAL system than playing games, we are screwed.
I haven't seen a school yet that hires an economics teacher, and has them fill in as a coach, but they all seem to be fine with hiring a coach and asking them to fill in as an economics teacher.
I have a friend who went to Canada to get her Laser Eye Surgery real cheap.
I don't know about you or your friend, but I wouldn't want the words "laser," "surgery," and "real cheap" together anywhere near *my* eyes.
"...always new atoms but always doing the same dance, remembering what the dance was yesterday." -Richard Feynman
The United States of America (our medical establishment) is primarily concerned with symptom/disease treatment. This is especially apparent in obesity and obesity related illness, where Insurance companies (for the most part) would rather dodge paying for expensive heart surgeries than a gym membership. As the saying goes, 'an ounce of prevention prevents a pound of cure.'
Costs are high because of several factors, first is the medical billing system. In our country we have countless carriers and each has a different form and another person you have to higher in order to understand what they will and what they won't pay for. This can add up to about 40% of a hospital's operating budget. A single payer health care system could take care of this, or a more standardized set of forms and practices.
Second is malpractice insurance. We are a lititgious society (in the United States) and punitive damages can get out of hand much of the time. For the most part, doctors are not being willfully malicious when there is an accident, or mistake. It is a high pressure job and they are there trying to help people. WHile they should be held accountable for their actions, this accountability should not become a barrier for treatment. Rather than capping punitive damages, Good Samaritan laws could be strengthened and applied to doctors and other emergency service workers, but that's just my opinion.
A single payer system isn't going to fix the problem, it's going to take a lot more than that, and we're not even talking about health care access.
Do not mix price and quality. Higher price doesn't necessarily mean higher quality.
Free XBox, PS2
As a Canadian, I'll chime in with a "me too."
As a US resident, I'll add "The more fundamental issue is that while Americans are increasingly eager to capitalise on the benefits of a nationalised health system, they are adamant in their insistence that such such systems are akin to something between a violation of human rights and communism, and implementing one will lead to disaster."
I disagree. Americans are medically-obsessed. I work at a boarding school, and I end up in the dorms fixing stuff quite a bit. I have yet to see a room without a bottle of 'scripted antibiotics in it. The school newspaper just made a joke about how much ritalin and adderal is abused for 'studying'. We overpay for every piece of plastic and metal that goes into medical care. The list goes on.
When I got a fungal ear infection and my doctor prescribed me antibiotics, which are exactly WHY I got the fungal infection, I stared thinking about it. I haven't taken a prescription since.
When I had to get my wisdom teeth out, I decided to do it at the dentist's office instead of the oral surgeon, I saved over $1200, and the fact that I was awake and could cooperate with the dentist meant that the surgery went smoother and safer, and I recovered much faster because they can really 'beat you up' when you're unconscious. I walked home with some cotton to soak up the blood and a bottle of advil for the rest of the week.
Why on earth would insurance pay for a full-on surgery to extract wisdom teeth? It can be done easily at the dentist's office for a third of the cost.
I really don't think the problem is litigation, it's certainly a problem, but not the major factor in medical costs. The major factor is American aversion to reasonable amounts of blood and pain, coupled with excessive trust in the medical institution and it's practitioners.
"Sometimes, I think Trent just needs a cup of hot chocolate and a blankie." -Tori Amos on Nine Inch Nails
We where in need of IVF (in vitro fertalization) and this is typically not covered by insurance companies in the US
Forgive my callous analysis, but 'needing' IVF is a subjective take on it. You wouldn't die or be sore or suffer in any objective terms if you were unable to conceive. While I feel for you, I think that any insurance company that did cover it would be driving up costs and doing a disservice to people who just wanted to stay well and not pay through the nose if they were injured or ill.
Adoption, while also expensive, is also a viable option. If you REALLY want your own biological baby so bad, pay for it yourself. don't burden the others on your insurance policy with paying for something that is unnecessary. And it seems you did, which is great.
The idea that the Netherlands mandates insurance for it is ridiculous. Sometimes life deals you a bad card. That's just the way it is.
Reason, free market capitalism, and individualism
It's plaintiffs lawyers (like John Edwards) suing doctors with junk science, judges not doing their jobs, and gullible juries. And of course the "defensive medicine" (runing every test just to CYA) that doctors practice to avoid suits.
And of course, legitimate malpractice claims.
Insurance companies just run the numbers and tack on a profit - they really are the least responsible.
If they doctors in India can do as good a job as the ones in the USA at a lower cost, I'll be traveling overseas if I have to have another surgery.
A BIG "if." What evidence do we have of this? Medical school admission in the US is extremely competitive, likely the most competitive academic process in the US. I'd like to see some evidence that "Indian doctors are probably at least as good as those one is likely to get in the U.S." There are competitive schools in India, but to make a blanket statement about Indian doctors is ludicrous. After all, don't a lot of brilliant Indians come to the U.S. to attend grad school?
Of course, if something goes wrong, don't look for a lawyer to sue - they are all in the U.S.!
Slashdot "libertarians": Small government for me, big government for those I disagree with. -1, I disagree with you
Diclaimer: I'm a physician who delivers babies.
There are a few bad doctors out there, and bad outcomes happen at times to all doctors. We could do better at policing ourselves.
However, the lawsuit-jackpot mentality is not helping the patients or the physicians. It helps the lawyer who gets to take his 30-50% off the top of a big judgement. As a rural family physician, I deliver 30-40 babies a year, but my malpractice premium is about $40,000/year. If I didn't deliver babies, it would be about $12,000. Disturbingly, 40K is actually pretty low for delivering babies. It helps that I live in a rural area.
I have to deliver about 30 babies a year just to cover my malpractice premium and office expenses. That's a lot of late nights, weekends away from home, etc. If I have a bad outcome, even if it wasn't my fault and the jury finds in my favor, my premium will still jump a good 25-50% or so. If you don't love delivering babies for the sake of delivering babies, you start asking yourself why you're exposing yourself to all this litigious risk, missing sleep, and paying higher premiums even if you're right. Then you start seeing physicians retiring or stopping high-risk procedures, and that doesn't serve anyone.
It's an easy sound bite to just blame doctors, or just blame lawyers. All the involved parties need to sit down and work out a solution. I'm afraid that this won't happen until enough pregnant women can't find a physician and end up being delivered in the emergency room.
Oh its easy to do that, simply cap the amount that lawyers get from the lawsuit at a fixed (not percentage) amount and a change in the way awards are done. Pain and suffering? Here's a trustfund to cover your painmeds and a shrink for as long as you need them. Punitive damages? If whatever was done was SO bad, throw the doc out of the profession. (and I'm not talking about the doctor who takes on the risky brain cancer operation that the patient was going to die in months without and patient doesn't survive even though the doc did everything right, or the people who sue the OB who delivered the baby for brain damage when their kid fails to get into Yale.)
Of course, you're not going to see the LAWYERS in charge around here fixing their profession anytime soon.
If I have been able to see further than others, it is because I bought a pair of binoculars.
I overheard an interesting conversation today, in which a gentleman discussed this exact statistic. I'm pretty sure he's an actuary, and apparently wrote an article about this data for some unnamed publication.
He mentioned that the 2% number is bogus, and went on to explain why. He commented that the numerator in that division was comprised of all doctors' malpractice costs, and that the denominator was all costs of all health care institutions, including doctors' offices, nursing homes, hospitals, etc. His conclusion was that if you corrected either the numerator or denominator of that equation so that they both measured costs for the same group of individuals/institutions, the picture wouldn't look appear quite so insignificant.
This wouldn't surprise me in the least, given the inaccuracies and misleading-at-best statistics that seem to run rampant in what we hear from politicians and the media. I sometimes wish there was a group of non-partisan accountants and statisticians who could analyse all this stuff for us and point out the glaring omissions we don't often see until reading the full text of such reports ourselves.
I think we do need some tort reform, and I do think that if it is done right, that it will result in significant savings.
The bulk of costs are not in settlements but actually in legal fees (discovery, court costs, etc). Therefore I propose the following changes:
1) Doctor's insurance covers patients up to a certain dollar ammount due to medical error. Dollar ammount is set by a government regulatory agency.
2) Patients also can purchase additional insurance for medical errors covering them up to a larger dollar ammount. This will be included, presumably, in the medical insurance.
3) Malpractice should be limited to those cases where one can demonstrate that the doctor should not be practicing medicine. However, medical error should automatically provide the patient with an insurance settlement.
Now--- I don't think that that I trust any candidate to do this so....
LedgerSMB: Open source Accounting/ERP
The percentage of people who have the personal resources to personally pay for the worst case health problems is in the low single digits. That means that health care gets rationed here in the USA, too. It's just a different system; people who have full-time jobs at large corporations usually get first priority. (Why does the size of your employer have anything to do with health care? Who knows.) Then come the perfectly healthy people who are allowed to buy individual policies, and people who work at small employers where none of their coworkers are too sick to lose the group plan. Lowest in the rationing pecking order are uninsured who rely on emergency room triage.
Oh, I forgot that half of the healthcare in this country is fully socialized. It's just for everyone who is old enough to get on medicare so that they can get free coveraged paid for by those of us who actually have to work (but don't get to actually benefit from the socialized healthcare we pay for ourselves).
At the end of the day, almost nobody is actually directly paying for their healthcare in the US anyway.
"Frivolous lawsuits" are less than 2% of the total, and hardly register in terms of actual dollars. No, the skyrocketing cost of medicine in the US can be firmly laid at the feet of PharmaCorps and the out-of-control insurance companies. Lawsuits actually went down in the past couple of years, yet malpractice insurance fees continued to rise.
In fact, ridding frivolous lawsuits and capping patient recoveries would not put a dent in medical costs. All that would do is take power out of the hands of judges who should be the final arbiters of what is and isn't a frivolous case and destroy the ability of plaintiffs to adequately address what, due to its nature, is a rather grievous harm.
You want to bring down the costs of medicine? Reign in the skyrocketing costs of drugs and insurance that doesn't adequately cover the insureds.
I have something in common with Stephen Hawking...
Funny thing, if you put people's money into a pool, and a Central Committee doles it out and dictates what can and can't be done, we call it Socialized Medicine -- EVIL!!
But if the people who dictate what can and can't be done also get to own the whole thing and rake off enough to get rich, we call it an Insurance Industry -- GOOD!!
50 years ago, there wasn't much that could be done for you beyond a couple of thousand dollars. Most people could be expected to pay for their own healthcare.
Now it's not unheard of to spend more than 1 million dollars on a single patient (one of my former employers mentioned in a benefits meeting that they had 5 $1 million patients in the previous year). Any reasonable person needs to have insurance, unless they're willing to die for the principal of frugality.
Health savings accounts are fine, as long as everybody qualifies, and as long as they always come with full insurance past some deductible that most people can afford. I do think that all health insurance plans should be required to have a high deductible to encourage people to shop on price. However, I also think that one way or another, there should be a single risk pool that amortizes the risk evenly over the whole population. This would greatly reduce both the outrageous costs of accounting in the insurance industry and the stress most people needlessly experience when they change jobs.
malpractice insurance costs are a significant but relatively small portion of the increase in healthcare costs in this country over the last couple decades
Malpractice has had an indirect effect upon the cost of healthcare in the US: it has raised the standard of care, at times to ridiculous levels.
Practicing defensive medicine, in order to reduce the risk of getting sued, results in many referrals that aren't strictly necessary. Trivial example:
30 years ago: Kid breaks arm, primary care doctor sees him ($), reads xray himself, puts a cast on, done.
Today: Kid breaks arm, primary care doctor sees him ($), refers to orthopedic surgeon ($$$), who orders xrays, which are read by a radiologist ($$$ for the consult), puts a cast on, done.
These days, if the primary care doctor takes care of it all himself, and the outcome is less than perfect, he'll get sued, and he'll lose because he didn't refer the patient. My point is just that American medicine has overused specialty consults for so long that it's become the standard of care, and now anyone who doesn't make the costly, unnecessary CYA consult risks getting crucified by a lawsuit. The obscene state of malpractice laws in this country have created enormous hidden costs in these uneccessary referrals.
Of course, everbody wants their sprained ankles seen by an orthopedic surgeon because, as you pointed out:
Once they hit their deductible they don't care what it costs at all.
This is just one more reason why socialized medicine is a bad idea. The absolute last thing the US needs is another layer of insulation between patients and the real cost of health care.
Well with all these old sick people, I have one great solution;
1. legalize medicinal pot, that will
A) fix lots of sick people for virtual no cost, who cares if there is no patent and some big corp gets no money out of it, I can live with dieing companies (those ceos can live on their 10M+ bank accounts easy), not dieing people. And I am not saying they have to smoke it, any one with 1/2 a point of IQ will realise that you can get the THC oils out and apply as a vapor or orally.
B) reduce the wasted (fake) war on drugs which does nothing, but ruin peoples lives by getting in goal or getting records. Or generally just giving them the 'criminal' label which stuffs up their career prospects (damn evil Dupont screws)
C) reduce wasted $$$ on police force/prisons etc... AHH BUT wait, theres private prisons and people are making money, and thats all they care about, not the people.
But I dont expect that to happen, since they are all so currupt and evil , worse than any pot smoker could ever be. May god strike them all down with cancer that will be expensive for their children to pay for.
Liberty freedom are no1, not dicks in suits.