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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...'"
"Thank you...come again.!"
I have a friend who went to Canada to get her Laser Eye Surgery real cheap. Apparently the company has an office here in Seattle, and a shuttle to Vancouver, B.C.
Now we don't have to worry about having doctor's in the US anymore, also... we can just get on a plane and go to India for medical care.
Add sarcasm tags where appropriate.
"In theory, theory and practice are the same; in practice, they are not."
£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.
I went to Asia Minor and all I got was this lousy Left Ventricle...
I sent my sinuses to Arizona
I sent my liver to Peru
I sent my lungs and my kidneys
For the summer to Sydney
But I'm sending my heart to you!
"This is news" was my reaction too. I don't know how long Brits have been popping across to the Continent to beat the NHS waiting lists, but I do know that the travel insurance I got in 2000 included exceptions for people travelling abroad for medical treatment.
There are India doctors as good as American ones. Most of them seem to be in the US as opposed to India. I also know somebody who was misdiagnosed while in traveling in India and nearly died.
Caveat Emptor!
Places like india and south africa end up supplying plenty doctors to western countries and i'd feel pretty confident that they'd do a good job.
Makes me wonder why someone doesn't just get a ship anchored in international waters off the coast of california to offer similar cut price procedures.
As someone who has had three open-heart surgeries due to a congenital heart defect, I can see this as a viable option if I ever have to have another surgery. I've had my aortic valve rebuilt once (valvoplasty) and had it fall apart, replaced with a Hancock prosthesis (pig's valve) which calcified when I went through a growth spurt at 16, and then had it replaced with a Saint Jude's valve. I've been ticking (literally) for the past 22 years. Yes, I had my brother tell me that I am like a Timex watch :->
My first surgery cost about $5,000 (in 1969); the second about $30,000 (in 1976), and over $80,000 (in 1982). You can thank the insurance companies for the cost of health care today. Malpractice insurance for doctors and surgeons in the USA can top $1,000,000 a year depending on their area of practice. The more delicate the organ they work on, the more they pay. In order to stay in practice, they have to charge the patient more. The patient's insurance company pays more, they raise the cost of the insurance, someone sues the doctor for leaving a sponge in them, their malpractice insurance rates go up, etc.
IANAL and I don't know about India's legal system, but I don't think they have the sue-for-every-mistake mentality we do here. Remember, doctors are people too and they sometimes make mistakes. 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.
If "disco" means "I learn" in Latin, does "discothèque" mean "I learn technology"?
And injured patients just get to suffer?
What?
My wife and I considered going abroad for the treatment we where facing too. We where in need of IVF (in vitro fertalization) and this is typically not covered by insurance companies in the US. Some numbers suggest up to 2 million americans are in need of this procedure. Looking at about $15,000 per procedure without a guarantee of success we considered getting treated in Canada (less then $10k per try) or even going back to the Netherlands where it is insured by law reducing the patients cost to ~$1200 per try.
Given that I am in the top 5% income bracket we opted for just taking the treatment and paying for it. Still not a great thing considering that it could take several treatments after which there is still no gaurantee of success (other then losing the money).
We got lucky. First time was a success.
I have been wondering how the millions of other couples in america for whom this procedure might be the last chance are dealing with the cost. Going abroad maybe?
The surgeons may be almost as good, but how good are the hospitals? Where's your recourse if they fsck you up? Sue for malpractice internationally for a pittance?
Things may be bad in the US, but not that bad, I hope.
A feeling of having made the same mistake before: Deja Foobar
First World health care at Third World prices
That really looks like it was taken from a sign on the Simpsons.
Off topic, yes, but, it's Friday.
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."
You even get to pick which street person will be the lucky donor.
Liberals call everyone Nazis yet they are the closest thing to it.
Yada yada. Without opportunistic clients the lawyers are never hired.
... and the list goes on...
Without opportunistic suppliers of over-expensive medical equipment medical costs could go down too.
argan0n
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.
--
make install -not war
For the $10,000/child/year we spend now on public education, you could probably send your child overseas and have him personally tutored by people with PhDs.
Seriously, he should have gone to Bangkok. Last time I visited, I met an Aussie who'd retired to Thailand for the cheap healthcare, and heard of several "surgery tourists" who also did the same. Reportedly the hospitals (at least the ones a paying tourist would use) are spotless, with english-speaking nurses and excellent care.
;)
On a less serious level, it's long been a well-known spot for budget travellers to get some dental work done, or pick up new glasses, cheap, safely and reliably.
It's even (IMO) a nicer place to visit. Sorry Indian readers
Why would it cost $200,000 to get heart surgery? (Or $100,000, or whatever).
I'd definitely go to India rather than face that kind of horrorific bill. It makes me think medical costs are truly out of control, and frankly, I don't want to pay them.
D
India is also the place where the locals bring their own sharps to the hospital to avoid contamination from inadequately sterilized second-hand needles. They've also got a really major AIDS problem.
But this isn't too far from reality. There was a group of cardiologists who decided to totally refuse any kind of third-party payment. No Medicare/Medicaid, HMOs, or even health insurance. If you wanted service, you paid for it, in cash, at the time of service. Their patient volume, as might be expected, fell by about three-quarters. Their income doubled.
Why? Because the government only pays about 30 cents on the dollar. This means that HMOs and health insurance companies pay a few cents less than that. So if the hospital bills for $200k, they're unlikely to get more than, say, $70k, which is only a little more than the total cost in India. If the hospital knows a procedure is going to cost $10, they'll bill for $30, because that's the only way they can cover their costs.
Governmental intervention in healthcare has shafted the very people it was designed to help: the poor. If you don't have health insurance and aren't eligible for Medicare/Medicaid, you're screwed, because while the government and major health insurance corporations can force providers to take a bath on two thirds of their costs ("Oh," says Uncle Sam, "Don't like what we're paying? Turn down a single patient and you can't treat Medicare/Medicaid patients for years!"), you can't.
Want to cut down on the spiraling cost of healthcare? Start paying what it costs rather than having bean counters in Minnisota who have never been to medical school and never treated a patient in their life determine, without any first-hand experience, what your surgery is supposed to cost.
Dick, get back to work. The last thing we want is to lose to Kerry because you farted around on slashdot.
Did you send the email to Gitmo about "Guest 1"? We've got to "find" him this weekend.
---
ECHELON is a government program to find words like bomb, jihad, plutonium, assassinate, and anarchy.
Here's the weird thing about the Canadian academic medical system.
Fact 1: Canadian doctors, especially rural family doctors, are in critical shortage.
Fact 2: It is hard as hell to get into Canadian medical schools (GPA: 3.8, MCAT 30-31 + Extracurricular)
Fact 3: There are hundreds of immigrant doctors in Canada driving taxi cabs.
If you said "WTF?" you're not alone. The reason why it's hard to get into medical school is easy enough to explain: When the government pays 70% of your tuition, you're gonna get high demand for a fairly well paying job (about $7000 USD/month).
But what makes very little sense is all these perfectly good doctors roaming the country with crappy little McJobs. The reason is because they can't get into residency programs to get certified. And they can't get into residency programs because Canadian graduates get first pick, and whatever's leftover goes to the immigrants. Since there's always never enough residency spots, and the one's that go to the immigrants are less desireable (family medicine).
That means we could have the world's best opthmalogist living in Canada, and the most he can hope for is it run a rinky-dinky clinic off in the boonies, if he's lucky.
Not sure how it relates to the story, but an interesting tidbit nonetheless.
Corporations: your universal scapegoat for all society's ills.
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.
--
Don't like it? Respond with words, not karma.
Perhaps for a routine non-emergency procedure this is a great choice. My Indian buddies tell me it takes 24 hours to get to India from Los Angeles, so this is definitely not for emergency procedures.
Of course it helps that Im from Brazil, but I live in the US and I go back home once a year
and get all my dental work done and any blood tests/whatever for maybe a 1/8 of the price I would pay here.
I have been to a dentist in the US and IMO the Brazilian ones are much better...
I have family members down there who got hair implants/breast implants/eye surgery/whatever for a much lower price than it costs here and they are all still alive, well, and had no problems with the work performed...
Who is this Karma guy and why is he bad ??
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.
So when do the poor and oppressed of the thrid world nations start offering their spare kidneys, lungs and children to the wealthy elite?
I work for a healthcare organization and one of our hospitals is in Bellingham, WA. We get a reasonable amount of business from Canada. Evidently there are people who aren't fond of waiting lists.
has been concoted by doctors unwilling to police themselves, afew bad lawyers and cases, who out of hte millions, get overreported, and most of all, the GOP/right wing conspiracy to shift this country into a darwinian dog eat dog capitilist mode.
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.
some like Japan have negative birth rates
You keep using those words, "birth rate"
I don't think you know what they mean.
Are Japanese women really going around, squatting over little children. sucking them up and injesting them? Because something like that is the only way you are going to get a negative birth rate.
Medical malpractice is less than 1% of the total US bill. Try again, and this time without simply mimicing GOP talking points.
Did you really name your son "Robert');DROP TABLE Students;--"?
Reason being I personally know one of the world's best heart surgeons who currently practices in India. He has done thousands of open heart surgeries, on people from virtually all rungs of life, politicians to business magnets to children from Iraq.
Infact I have been thinking to start my own little medical tourism practice on the side to encourage people to seek medical help in India. India has some of the world's most renowned doctors and some of the cheapest rates. The care you will experience will be top notch as well. Most people (uninformed as they might be) tend to think "unhygienic" when they hear "India". However the private hospitals are luxurious, has the best doctors your money can find and you will receive the best care your money can ever buy.
I am not trying to discount the experience or the ability of doctors here, but when your Insurance wont pick up the tab, and your surgery costs around 100k, and you can get it done by a top notch physician/surgeon sitting half way across the planet for 1/10th of the price, you would be crazy not to take notice.
If you want to receive additional information, email me.
Rapid Nirvana
I had a Japanese society teacher who experienced something similar in Japan (and Japan is a lot more expensive of a place than India!). Both the US costs were about the same, and the cost in Japan was about what this person paid in India. Probably a rare case, but still.
The US medical system costs an utter fortune. Last numbers I saw, the average American spends - between out of pocket expenses, company-paid expenses, government expenses, etc - over 4,500$ a year. The next closest, in terms of cost, worldwide was Britain, at about 2,900$. I can check for a ref and updated numbers if anyone wants.
Compared to how much we pay, we're getting ripped off. Even Cuba, which is under an embargo that covers medical supplies, has almost as long of a lifespan as the average American does.
Did you really name your son "Robert');DROP TABLE Students;--"?
Indeed. A large chunk of the patients in hospitals in northern France have come from the UK for quite some time now.
It is faster than the NHS, cheaper than private clinics, and closer/safer than India.
The US market for doctors is a monopoly. The AMA gets final say in who is and is not a doctor. They limit entry into the field. They regulate those that are in the field.
The existance of a monopoly has more effect than even insurance. There is little to no competition among doctors because the number that the AMA allows to be licensed every year is so small. I've heard all the stuff about limiting the number to make sure they are all competent, but that is a crock of shit. How do I know? Because I know some very competent doctors that were rejected a few times before they were accepted. There simply weren't enough spots for them in the schools. Eventually, they got in, became doctors, and lived happily ever after.
The situation reminds me of the cab drivers here. The city council created a fixed number of licenses. Then, they made it so that the license holders have control over new licensees. The effect is that there can never be any new licensees unless the law changes. So you have to pay someone for their license, and they are running at about $40,000 each. That's right, because the people whose income depends on their ability to restrict others from the market are in charge of that market, they will exclude everyone else to increase the value of their license. It is the same with the AMA putting doctors in charge of licensing doctors, and getting the force of law behind it.
Of course, if you try to add medical schools (which have to be AMA certified) they will balk that you will kill people with all the unqualified people that will get in. FUD, it's not just for breakfast anymore.
Oh, and the medical insurance costs don't help, either. And most of the problem with that is the juries. "Shit Happens" should be a valid medical defense for most of the suits. They are cutting you open and moving things around, things will sometimes not go right. If you have a problem with that, don't go in. If they operate drunk, sue them. If you agree to a proceedure and decide later that if it were done a different way the outcome may have been different, then you should sue yourself for being stupid and not getting a second opinion.
Learn to love Alaska
No, they just get paid actual damages.
In the few cases where there SHOULD be "punitive damages" (i.e. due to gross negligence rather than things that just happen because medicine is and never will be perfect), it should be awarded to the state to benefit everyone, and the lawyer should get no cut of it.
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
If some thing goes wrong then how can I sue the crap out of them?
If a couple lacks the native ablilty to reproduce unaided then perhaps it is for a reason, no?
That hurts man. Seeing that someone believes that crap about 'devine reason'. If it was available, would you have gotten the flu vaccine or is it meant to be that more people will die this year because of the flu vaccine shortage? If a condom can stop VD's and prevent unwanted pregnancies, are you really claiming that we shouldn't use them? Do you take responsibility for your actions? Do you think for yourself? Columbine or 911, was there a devine reason?
My wife has Endometriosis and there is no reason for this. IVF provided us with the ability to raise our biological offspring. Why is this important? Because our brain makes us think it is. Yes it is hardcoded in our brain to produce offspring, and though we have the capability to ignore our basic instincts it takes an effort. Going with the natural flow of things is, well, natural.
So do your sister a favor. Let her listend to her body while you listend in private to your god.
Have a happy life.
By "Medical malpractice", do you mean just the lawsuits or does that include insurance premiums as well? And can you give us the source of your figure?
According to this report by GAO, it seems that the malpractice premiums are going up but the insurance comanies' net loss is growing as well. That leads me to believe that only one who's profiting from this are the lawyers. So try again, and this time without simply mimicing Democrate talking points.
1f u c4n r34d th1s u r34lly n33d t0 g37 l41d
I call bullshit. My employer builds a next-generation EMR system (electronic medical records). Our two top executives are doctors, and I think there's a total of about 14 on staff, from a number of different specialties (since we need data for our created for doctors in all the different specialties we want to sell to).
All of them have horror stories about how hard it is to find specialists for certain fields, particularly in rural areas (which Texas, which I'm in, has a lot of), because the cost of malpractice insurance is so high for those specialties.
So no -- malpractice insurance is a real problem, and a big one, I'm not using GOP talking points, but rather hallway-conversation with my coworkers who've genuinely been there.
That is the problem, emergency rooms can not turn anyone away. However by the time someone needs to go to the ER whatever condition they were in has most likely become much more expensive to treat. Thus it costs us MORE to not have a true single payer health system.
I am an Indian living in the US. My parents are both doctors - working in one of the hospitals mentioned in the article. Here is their take on the entire Indian medical system.
... and Indians are taking a cue from the US and filing malpractice lawsuits in increasing numbers. So, if you are looking to India for cheap medical treatment, better go there quickly. It isn't going to remain that way for a whole lot longer!
The very best Indian doctors and hospitals are, for all practical purposes, as good as any in the West. Unless you are looking for technologies and treatments that are on the very bleeding edge, chances are that it is available in India for a lot less than you would pay here.
The average Indian doctor and hospital are, however, a lot worse than what you get here. Over here, I can walk into any doctor's office, any hospital, and can be assured of a fairly decent standard of treatment. That is not so in India. Outside of the few top hospitals (most of which are located in the major urban areas), it is a total crapshoot. You may get a good doctor but it is equally likely that you will get a complete incompetent who would have had his license revoked many times over in the West.
I lost an uncle of mine to such a quack - in Bangalore of all places (where you would expect a decent level of medical expertise). He was hit by a truck and the idiot doctor who attended to him did not realize that while he didn't look too bad externally, he could be bleeding fairly severely on the inside. So they just sat and watched him bleed to death over the space of several hours.
As far as the cost advantage is concerned, it is there but will slowly get less over time. Medical treatment in India is getting dramatically more expensive each year
- HCE
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
Yes, the Canadians love their government-run healthcare so much that the private sector medcial centers are growing. I don't even like Rush Limbaugh so I'll use the actual Canadian news sources.
Canadians want 2-tier health: poll
British Columbia is looking to expand its use of private medical clinics
Private medical clinic opens in Montreal
Pettigrew open to discussing role of private MRI clinics
Even the Canadian medical pot users complain that "He doesn't need government-grown schwag that costs $150 Canadian per 30 grams"
I suppose you are going to aruge that Rush Limbaugh controls the Canadian media because they disagree with you? Do you own research, folks! Blindingly following Socialists is as danagerous than blindingly following the Republicans or Democrats.
1f u c4n r34d th1s u r34lly n33d t0 g37 l41d
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.
All of them have horror stories about how hard it is to find specialists for certain fields, particularly in rural areas (which Texas, which I'm in, has a lot of), because the cost of malpractice insurance is so high for those specialties.
It isn't that the cost is too high, it is that the number of procedures to amortize the cost over is too low. If you buy insurance for a car for $1000 a year, that's not too bad - about average. But if you only use that car once a year, then you are operating at a great loss. It would make much more sense to rent a car for that one day, buy the LDW for $30 and be done with it. The same goes for rural doctors. They will see so few specialty cases that it makes economic sense to not be able to treat them. The insurance cost wouldn't be high if they saw one a day. But at one a month, the cost per patient is so high that the caps put on by insurance carriers would have all the patients traveling to other places, rather than pay the surcharge he'd be forced to pay.
So yes, insurance is killing the small-town doctor. Just as All-Children-Left-Behind is killing the rural schools. The laws are written by big-city people with big-city visions. The small towns are getting the shaft. On top of that, Bush was pressing to get rid of the Universal Service Fund, which would lead to big spikes in telephone cost for rural areas as well (not picking on him, both parties are about equal in their press for the city vote at the cost of the rural areas, but that is just another recent example).
Learn to love Alaska
forgot where:
"the us is a good place to get a heart attack, and canada is a good place to get cancer"
mainly because the us healthcare system is set up in such a way that sudden major healthcare crises are well handled (pay later), but chronic long-term problems are not well-treated (pay first)
meanwhile, canada is the opposite
the fact is, in spite of this article, the rich of the world come to the us for their healthcare, because although affording american healthcare is difficult, it really is top notch in the world (mainly because of all that money)
there's no such thing as a free lunch, and eventually we all die, so healthcare, no matter how you slice it, is a triage system
always was, always will be a triage system: you have a limited amount of money to spend, and you have to decide where to invest it, and there are infinite ways to spend the money, because someone always has a health complaint
therefore, we will always be unhappy with our healthcare no matter what we do, because of the nature of the beast: we are human beings, we fall apart every day, and none of us have enough money to ensure all of us fall apart gracefully
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
If something goes wrong, can you hold someone responsible? This is an issue in the USA, but it might be more difficult overseas.
The medical industry is booming. Huge hospital corporations and drug companies are raking it in by the truckload. Medical insurance companies (which sell malapractice insurance to doctors and also medical coverage to patients through different branches) are also doing business like viking raiders in a monestary.
People in Canada, New Zealand, and Australia pay about 1/2 of what we do for medical care, and live as long or longer.
A better way to characterize the Medical Industry today is to say that it is were the American Automobile industry was in 1970. Those dental trips to Mexico ? Think of them as the VW Beatle. The heart trips to India ? Those are the Toyota Corolla, baby -- and a lot of rich Republican doctors and hospital board members and insurance executives will never see it this good again.
AMERICANS wake UP! This is what happens in countries that have socialist medicine and it's coming here! Yes we have big problems with the cost of health care here that need to be fixed but the solution is not to do what they do in the UK and Canada.
To add to my previous statement: don't think that you aren't paying for it too. Canadians spend about $2000 per capita per year on healthcare, while we spend $4000 per capita per year on healthcare. Sure, for Canadians that money is spent in the form of taxes, and for us it's in the form of health insurance payments, but at the end of the day, that's an extra $2000USD out of your pocket every year.
A deep unwavering belief is a sure sign you're missing something...
1. Healthcare is expensive in the US because of high malpractice insurance. ... Moreover, he added, a New York heart surgeon "has to pay $100,000 a year in malpractice insurance.
From the article: Trehan, 58, a former assistant professor at New York University Medical School who said he earned nearly $2 million a year from his Manhattan practice
This guy was making $2mil a year, and paying $100K for MI; just 5%.
2. Doctors there are bad
The founder (as quoted above) was an Asst Prof at NYU, making $2M a year. In fact, a lot of the doctors you find here (in the US) are graduates from the same Indian schools. And many of them working at these top hospitals are those who returned from US/UK. You'll find a good number of them holding advanced degrees (like FRCS) from institutions in US/UK. A good friend of mine (an Indian who finished his residency here) is going back because he couldn't get into the top school he wanted for research. He has his choice of places where he can practice, but he prefers to go back because he says "if I'm going to practice, might as well do it at home". There, the good doctors are put on a pedestal and have a lot of clout in society.
3. Facilities are bad
The hospital mentioned, Escorts, is top-notch and was founded by an Asst Prof at NYU who gave up a $2M/yr package to go back. Here's another quote from the article: Escorts is one of only a handful of treatment facilities worldwide that specialize in robotic surgery,
4. Quality of care will be bad .8 percent. By contrast, the 1999 death rate for the same procedure at New York-Presbyterian Hospital, where former president Bill Clinton recently underwent bypass surgery, was 2.35 percent, according to a 2002 study by the New York State Health Department.
From the article: the death rate for coronary-bypass patients at Escorts is
5. It is cheap because it is bad
Again, from the article: For example, a magnetic resonance imaging (MRI) scan costs $60 at Escorts, compared with roughly $700 in New York
I will relate a personal story. A very good friend of mine hurt his back (slipped disk) while travelling in India in 1997. He had to be hospitalised, and operated upon. After operation, he got 1 month of in-home nursing care. The total bill? $4000.
When he came back, he told his insurance company about this. They asked him to go to a local doctor. He checked him out, and said that the job the Indian doctors had done was as good as anything they would have done locally. And the insurance company paid the $4K even though he hadn't followed procedure (called them and sought approval), saying that just the MRI alone here would have cost $4K. There, the MRI, surgery, post-operative care, etc. all came at the price of just an MRI here.
At the last company I worked for (a small consulting firm), we had a meeting where we collectively chose the best health care plan we could find for the company. We all had full medical, dental, and vision benefits. I was under the impression that we had gotten some of the best coverage available, and even had some receptionists comment to that fact.
However, when it came to dental, we got screwed. I went to get my ancient fillings replaced, and was told it would cost something like $6-7000, and my "insurance" would only cover half. Furthermore, my "insurance company" was so bad at paying their bills, the dentist had hired a full-time person solely to try to get them to pay. It had gotten so bad that the dentist refused to honor the insurance... I would have to pay in full, then they would give me the appropriate paperwork, and I would have to seek restitution from my "insurance company."
Cut to: I go to Colombia. Guess what, they have the same high-tech dentists' offices as in the USA, some with bilingual dentists trained in the USA. And to replace my fillings only costs a few hundred bucks. Cash.
Let's see: $6-7000, plus a raftload of paperwork and headaches to try to get my worthless, deadbeat "insurance company" to pay up. Or, $1400 for airfare and an awesome week's vacation, plus dental work.
Like Mr. White says, ain't no choice at all.
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.
Parent is not a troll.
There is a correlation between this behavior and socialized medicine. Especially if that medical system has "waiting lists".
Canadians have come to the US. Brits have gone to India, France, the US. I'm not saying it's a huge trend. But people with money... want healthcare *now* and they will find ways of doing it. Canada has *actually JAILED* doctors for opening a private MRI clinic. That's just plain silly.
Not to mention the story about a Canadian who's son was gravely injured... he brought is son to the hospital, but he couldn't be admitted without a paramedic or an ambulance. So they waited... while the son died... for an ambulance to come from across down so he could be admitted.
Oddly enough Americans are outraged that it's illegal for them to go north and LEECH off of Canada's heavily subsidized presription drugs.
This is a serious issue with rationing health care because now you have given people motivation to leave the country to get (possibly) substandard healthcare. (But that's better than certian death on a waiting list, no?)
Figuring out who will and who won't get healthcare is a terrible choice to make. That being said no matter how you do it it'll be unfair. I personally happen to believe that it's *least* unfair when you directly pay for a service.
~foooo
...when we're talking about tech or IT jobs, but its really good when ordering medication or getting healthcare that is 'as good as here'? Make up your minds people.
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
I thought it was that Canada negotiates lower prices for prescription medicines, not that they actually put funds into buying the drugs.
This site says that the drugs are cheap in canada due to price controls and bulk buying.
The problem with this is that they base the price on the per unit production cost, not including research/development/certification costs. For a reasonable return, the company has to make it up somewhere, mainly in the USA. Drugs in the USA are cheaper once the generics make it to market.
I don't read AC A human right
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!!
I wonder if that's at least partially because Cuba has been denied access to American hamburgers, potato chips, donuts and soda pop (not to mention 1/10 mile car trips)?
One major cause is in the demographics. America (as is most of Western Europe as well) is getting older on the average, and old people cost a lot more to treat than younger people. That's only going to get worse over the next 30 years, and it's going to get far, far worse. Medicare is going to collapse under the promises it made decades ago, and nobody in Washington has the balls to do anything about it for fear of angering the AARP. The end result is that the system will come close to collapse under trillion dollars of debt, and it will have to be made up out of emergency tax increases on those of us younger than baby boomers and our children. I predict we'll see the Medicare tax go from it's already high levels to over 25% or even 30% of your income within my lifetime. The cowards in Washington DC are simply allowing this to happen.
The other big cause American health care costs so much IMNSHO is simply that it's a "for profit" system. "For profit" means that somebody is making money above and beyond the basic costs of providing the care. Look at the stock price graphs of the major hospital mangement companies, HMOs, and pharmaceutical companies. Every single point of increase in that stock price reflects a huge profit above and beyond the basic costs of providing health care. A lot of the increase in costs is going into investors pockets (including mine since I have held shares in pharmaceutical companies in the past, though not currently).
The supposed benefit behind the idea of the US system of private health care is that the profits are more than offset by the benefits of 1) competitition between different providers, and 2) increased efficiency and decreased corruption as compared to a governmental system. For various reasons, these benefits have not panned out.
Re: #1 -- Competition exists only to a certain extent between providers. The problem in health care is that the end-consumer of health care (who is insured) is relatively price-insensitive to the actual costs and bills generated from their care. Once they hit their deductible they don't care what it costs at all. The newest and most expensive thing must be the best, so we'll all go for the most costly stuff around. Supply and demand for physicians also doesn't quite follow the simple economic principles we all know and love. One or two interesting studies done some time ago (I don't have the references handy) found that physicians basically create their own demand. Even in areas supposedly "saturated" with doctors, adding more doesn't decrease the prices, it just creates more demand.
Re: #2 -- Increased efficiency is sometimes seen in private hospitals over public ones, but having worked in both I can't say that it's a big difference. Since there's little price sensitivity, why bother ever lowering your prices? Jack up the bills and buy more expensive toys! Efficiency is further decreased in American hospitals by the absolutely amazing explosion in the number of administrative (non-patient care) staff to do the paperwork, file the claims to a slew of governmental and private insurance companies, twiddle their thumbs, or whatever. American hospital CEOs make far more than their European counterparts, and they have much larger highly paid staff than in Europe. I've never worked in a hospital where the hospital CEO made less than two or three times what I do, even if they manage the hospital
"No, no, no. Don't tug on that. You never know what it might be attached to."
At the end of the day, almost nobody is actually directly paying for their healthcare in the US anyway.
That's because everyone is foolish. 50 years ago everybody *did* pay for their own healthcare plans. But during WW2 employers were not allowed to increase wages of their employees. To compensate the employees(instead of raises) they paid for health care and other benefits. Eventually everyone got used to it, and now you have our modern healthcare and benefits packages.
However, these days since everyone changes jobs every couple of years they get screwed. Transfering between employer health care plans when you have downtime, 'applying for health care', and getting screwed by 'pre existing conditions'. All these problems go away if you just pay for it yourself.
Unfortunatly people feel they aren't getting 'all that they can' out of their employer if they do this. However that means they get screwed when they change employers. I pay for my own health care because I'm a contractor, and all I hear are insane stories about people who switch jobs and get screwed.
This is going to change hopefully, President Bush established a HSA(Health Savings Account) plan which encourages people to manage their health care themselves. This not only encourages investment but makes health care costs cheaper. I've opened one and I know I'll have reasonable health care costs.
- "Never let a computer tell me shit." - DelTron Zero
The gist of the arcticle you site is that we really don't have any good estimates of what the costs are. A 1999 GAO study quoted in the article you sited concludes "Given the limited evidence, reliable cost savings estimates cannot be developed." Likewise a '94 OTA study mentioned concluded "it is impossible in the final analysis to draw any conclusions about the overall extent or cost of defensive medicine." So perhaps that the estimates are in fact too low, not too high.
The definition of "frivilous lawsuits" is slippery--there are plenty of highly paid "expert witnesses" who will solemnly swear that Dr. X egregiously breached the standard of care, when any other physician who hears about the case will call the allegations pure BS. Also note that frequently every doctor who saw the patient gets sued once the lawyers get started. So even if the suit itself may have some merit against 1 physician, 9 or 10 other pysicians are also sued without true justification, all in the same suit. Such suits may not be labeled as frivolous, but for 9 of the 10 defendents it is.
I'll grant that I'm biased on this. I am a physician, and I've been sued for malpractice once. By a patient who I had never seen who had been in a hospital I had never set foot in. Despite the fact that I had nothing to do with this person in any way, it took 9 months to get myself dropped from the suit (which involved ~10 other doctors and 2 hospitals for charges that were BS). So I've had an intimate experience with this issue.
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.
I will support Universal Heath Care when they come up with a system such that each and every citizen recieves the exact same heath care---starting with the President. If I have to sit on a waiting list for 6 months for surgery so should the President, Legislature, etc.
Knowing that is never going to happen I am completely against Universal Health Care. Do you actually think you and John Howard recieve equal care? Heck, politicans here won't even trust their kids to public schools let alone public health care!
Health Care--like food and land and every other resource--is a limited resource. Not everyone can eat lobster everyday and live in a mansion and afford to go to an Ivy league school. Not everyone can receive the top best healthcare. That is just reality.
What happens in "Universal Health Care" is that the powerful get their health care while what is left over is spread out thin between everyone else. At least in our system if I work hard enough and have a good job I can get good health care. To me that is much more fair than having my health care decided by whether or not I'm in politics or by "who I know".
Brian Ellenberger
If the US health system is so great, explain this to me...
The US spends more per capita than any other nation on earth-- so why don't we have the best infant mortality rates and life expectancies?
My theory is that we're being robbed-- what's your explanation?
And I trust that you stay away from doctor and dentist offices, hospatials, and other places where you can recieve artifical medical care? Hell, you should leave the band-aids on the shelf... just let nature run its course.
Only $4000 a year, that's a deal..
I pay $500 a month for insurance that has a $2500/yr
deductable. Why, because I'm self employed and dont have my employer paying part of the bill. Dont forget, in hte US, for the most part, you employer does pick up part of the bill.
The reason for keeping it, if I ever have to go in for anything, having insurance keeps the bill down. If I went in for anything and had no insurance, I'd have to about 3-5X more. That's the way it works..
Starman97@Gmail.com (bring it on spammers)
Great, so the population is undemanding of intelligent media, so the media dumbs things down, so people become less informed, and less questioning, and hence less demanding of intelligent media so... You're heading for a cultural meltdown, and regardless of who is "at fault" you need to do something to break the cycle.
Ever listen to "Amused to Death" by Roger Waters. It seems to make more and more sense to me as time goes by.
Jedidiah.
Craft Beer Programming T-shirts
You are absolutely right. I used to sell health insurance and I am currently CTO of a company that provides medical practice automation software (which includes claims processing).
When I have had to pay for my own health insurance I get a policy with at least a $5,000 deductible and high maximum benefit. I also open an MSA (Medical Savings Account). That way I pay for my family's routine visits out of my own pocket (cheaper than comprehensive insurance over the course of a year) and I am still protected against a major medical catastrophe.
The next layer to add to this is to, before telling the MD you'll be paying cash, ask if you can get a discount for cash. Sometimes (often?) you can since, on average, it saves the MD about 20% to not have to go through the claims process.
The result is a health insurance set up which is portable and relatively affordable.
Ok, I was just in India last summer and this is the first hand experience I had regarding medical care, and medical education. First, if you are in top of your class on the STATE-WIDE medical exams... you are advertised in the local newspapers by each of the schools in which you were educated, bragged about in the local newspapers, and get the MOST ATTRACTIVE, and WEALTHY spouses. Yes... very simple, if you study and work hard, and get the top scores, you get a FREE education, (every school is REQUIRED by the state to keep a certain number of spots free for the top students) and you get the absolute BEST in life, respect, wealth (relatively), status, and power. Secondly, my father happened to need treatment for a throat irritation. He visited a local physician, at his HOME, on a SUNDAY, got a prescription for the SAME antibiotics you get in the States, and spent a total of 250 rupees = ~$5. Finally, EVERY student in INDIA aspires to be a doctor. All those outsourced computer programmers are actually the SECOND rank of students. If you can manage to do so, you Strive to get into a medical program. The average doctor makes between 30,000-45,000 rupees per month = ~$1000/month. versus a programmer who makes 15,000 rupees/month = $300, even when your working for US companies! (These are not numbers I am pulling out of thin air, I have relatives and friends that make these exact salaries) Finally, my wife, if she were in India, as a trained and licensed physical therapist in India, makes 750 rupees ($15) a week in India. (A man would make about a 1000 rupees) Here, she will earn about $1200/month. Also, my grandfather (86 years old) suspected that he had some sort of tumor in his foot. He visited a hospital in Trivandrum, which was established by American trained physicans from Texas. The facility was spectacular, and easily of the same quality as you would see here in the states. However, there was twice the staffing! He was waited upon by a physician (yes an MD) within the hour that he arrived. I was really impressed. My father in law, 3 days ago, had a mild hard attack. He went to intensive care, with 24 hour monitoring for 3 days! And the total cost is less than $200. So, it is not at all surprising to me that medical care is the next big shift. In fact, I changed my medical insurance to catastrophic coverage only. If I need anything kind of care that is not an absolute emergency, I will just go back to India.
In some countries government programs can be very effective. In the US, however, there is no tradition of that, and the mind set for effective government programs just seems to be completely absent. I think that in the US, a universal health care system could be even worse than what exists now.
Finally! A year of moderation! Ready for 2019?
it saves the MD about 20% to not have to go through the claims process
Serveral things to watch out for...
1. Needed services often increase dramaticaly along with fee's for cash Pt's.
2. Insurance companies establish "Usual and Customary fees" and generaly only pay those or a percentage, if the Dr. accepts the insurance; it means that he/she also accepts the fee structure. Normaly they bill the Insurance their normal fee's, the insurance pays the usual and customary, and the DR. writes off the difference. The idea is by billing more than they are willing to accept, the usual and customary goes up. As a cash Pt you may only get a portion or none of the difference how about a 10% discount on a bill inflated 100%.
3. Frequently the insurance looks at things as a package, and only pay so much for a proceedure, as a cash Pt. your probably going to get ala carte pricing i.e. pay for each and everything, offten at 100-1000X mark-up.
4. If your Dr's morals-ethics are looser than most, he'll think "no insurance, medicare-medicade audits, no ovesight of any kind, PT Barnum was right."
I think the biggest problem is the insurance in the first place, insurance is big-biz, which needs lawyers, which attracts more lawyers. This results in law suits, which attracts more lawyers ad-nauseum. All of this drains resources away from healthcare and into legal.
Apocalypse Cancelled, Sorry, No Ticket Refunds